【摘要】目的研究腹膜透析患者不同腹膜初始转运状态磷清除率对血磷及预后的影响。方法横断面调查单中心规律随访超过3 个月的患者，收集透析初始月血生化指标，透析充分性及腹膜平衡试验，对不同转运功能之间血磷、腹膜及尿磷清除率及临床转归进行比较。结果共调查504 人，高转运患者透析初始月血磷低于低平均(F=5.452，P=0.020)及低转运患者(F=9.441，P=0.003)。腹膜磷清除率与4小时肌酐D/P(r=0.280,P＜0.001)、透析剂量(r=0.452,P＜0.001)呈正相关，与尿磷清除率(r=-0.205, P=0.020)、血磷(r= -0.332，P＜0.001)、肾小球滤过率(r=-0.229，P=0.004)呈负相关。ROC 曲线示腹膜磷清除率预测高磷血症曲线下面积(AUC)为0.682(95% CI：0.584～0.723,P＜0.001),截断值为28.75L/W，低及低平均转运患者nPCR 预测高磷血症AUC 为0.660(95% CI:0.577～0.742，P=0.001)，截断值为1.026g/(kg·d)。COX 生存模型示：高龄(OR=1.055,95% CI：1.003～1.193，P＜0.001),透析初始月低白蛋白(OR=0.907,95% CI：0.871～0.945，P=0.001)是所有患者死亡的独立危险因素，低尿磷清除率(OR=0.430,95% CI：0.213～0.866,P=0.018)仅对腹膜转运功能较低的患者是死亡的危险因素。结论腹膜转运功能越低，腹膜磷清除率越低，血磷越高。低尿磷清除率是腹膜低及低平均转运患者全因死亡的独立危险因素。
【Abstract】Objective To investigate the effect of phosphate clearance on serum phosphate and prognosis in primary peritoneal dialysis patients (PD) with different peritoneal transport status. Methods The patients who were primarily treated with PD and regularly followed up for more than 3 months in a single center were involved in this cross-sectional study. Their blood laboratory results in the first month of PD were collected, and their PD adequacy and peritoneal membrane function were evaluated. Serum phosphate, phosphate clearances by peritoneum and kidney, and clinical outcome were compared among PD patients with different levels of peritoneal transport functions. Results A total of 504 PD patients were enrolled in this study. Serum phosphate in the first month of PD was lower in the high peritoneal transport patients than in the low average peritoneal transport patients (F=5.452, P=0.020) and low peritoneal transport patients (F=9.441, P=0.003). The peritoneal phosphate clearance was positively related to the 4-hour creatinine D/P ratio (r=0.280, P ＜0.001) and dialysis dose (r=0.452 P＜0.001), and was negatively related to the urinary phosphate clearance (r=-0.205, P=0.020), serum phosphate (r=-0.332 P＜0.001), and glomerular filtration rate (r=0.229, P=0.004). ROC curve for the prediction of hyperphosphatemia by peritoneal phosphate clearance rate showed that the area under the curve (AUC) was 0.682 (95% CI 0.584～0.723, P＜0.001) and the cut-off value was set at 28.75 L/W; ROC curve for the prediction of hyperphosphatemia by nPCR in low average peritoneal transport patients and low peritoneal transport patients showed that the AUC was 0.660 (95% CI 0.577～0.742, P=0.001) and the cut- off value was set at 1.026 g/kg/d. COX survival model showed that older age (OR=1.055, 95% CI 1.003～1.193, P＜0.001), and hypoalbuminemia in the first month of PD (OR=0.907, 95% CI 0.871～0.945, P=0.001) were the independent risk factors for death in all PD patients, and that low urinary phosphate clearance rate was the risk factor for death (OR=0.430, 95%CI 0.213～0.866, P=0.018) only in PD patients with lower peritoneal transport function. Conclusion ①The lower the peritoneal transport function, the lower the peritoneal phosphate clearance rate and the higher the serum phosphate level. ② Low urinary phosphate clearance was the independent risk factor for all-cause mortality in PD patients with low peritoneal transport function and low average peritoneal transport function.
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