不同残余肾功能腹膜透析患者临床分析

目的观察终末期肾衰（ESRF）患者在腹膜透析（PD）患者残余肾功能（RRF）对临床生化指标及生存率的影响。方法所有患者按残余肾小球滤过率（rGFR）水平将其分为两组：一组rGFR〈1 ml/（min.1.73m2）;另一组rGFR≥1 ml/（min.1.73 m2）。每3个月进行一次临床随访,全面评估患者的全身情况及透析状态,包括血压、身高、体质量、体质量指数（BMI）、尿量（UV）、残余肾肌酐清除率（Ccr）、每周总尿素氮清除率（Kt/Vtotal）、每周肌酐总清除率（WCcr total）、残余肾尿素及肌酐清除率。对比观察不同RRF状态透析患者临床生化指标变化。结果两组不同残余肾功能状态患者的2年死亡率为8.3%和30%（P=0.034）,血红蛋白、钙磷乘积、血清白蛋、Kt/V total、Ccr total、24小时出液量分别为103.6±9.8和94.2±9.2（P=0.003）、47.3±3.8和53.3±4.2（P=0.048）、35.9±3.2和31.6±4.1（P=0.003）、2.20±0.25和1.98±0.98（P=0.002）、67.4±7.2和55.9±5.9（P=0.000）、1014±205和661±160（P=0.000）。结论残余肾功能可以影响腹膜透析患者的造血、营养状态、钙磷代谢、炎症状态、容量状态等,保护残余肾功能可提高患者的生存率。

Clinical analysis of peritoneal dialysis patients with different degrees of residual renal function

Objective To investigate clinical characteristics,and outcome of peritoneal dialysis（PD） patients with different degrees of residual renal function Methods Sixty-eight continuous ambulatory peritoneal dialysis（CAPD） patients（34.5% being completely anuric） were enrolled in this study.Assessments of mortality and biochemical parameters and indices of dialysis adequacy were done at study baseline and were related to outcomes.Results During the prospective follow-up of（11.1±4.9）（mean±SD） months,The overall 2 year patient survival was 91.7 and 70.0% for patients with rGFR ≥1 ml/min per 1.73m2 and anuric patients,respectively（P=0.034）.Compared with patients with rGFR ≥1 ml/min per 1.73m2,anuric patients were more anaemic（P0.01）,and had higher calcium-phosphorus product（P0.05）,higher HS-C-reactive protein（P0.001）,lower serum albumin（P0.01）. Conclusion RRF play a key role in maintenance of fluid balance,biochemical homeostasis and PD adequacy status,suggesting that patients with and without RRF are qualitatively different.