目的 探讨腹膜透析(peritoneal dialysis，PD)患者腹膜转运功能变化及其与心血管事件(cardiovascular events，CVE)的关系。方法 选取2014年1月1日～2019年12月31日于安徽医科大学第二附属医院腹膜透析置管后行PD的患者114例，随访至发生CVE、改为血液透析或肾移植、失访、死亡或研究终止日期(2021年12月31日)。根据4小时腹腔引流液肌酐与血浆肌酐比值(4hD/Pcr)变化分为增高组(70例)和降低组(44例)。比较2组患者CVE发生情况并采用COX回归探讨PD患者CVE的影响因素。 结果 共44例(38.6%)患者发生CVE，其中增高组22例(31.4%)，降低组22例(50%)。增高组累计无CVE比例高于降低组(χ2=4.000，P =0.046)。多因素COX回归分析显示4hD/Pcr变化(HR =0.093，95% CI：0.013～0.662，P =0.018)和合并糖尿病(HR =2.824，95% CI：1.441～5.535，P =0.002)是PD患者发生CVE的独立影响因素。 结论 4hD/Pcr降低的PD患者发生CVE的风险更高。
Objective To investigate the changes in peritoneal transport function and its influence on cardiovascular events (CVE) in peritoneal dialysis (PD) patients. Method A total of 114 patients who started PD in the Second Hospital of Anhui Medical University from 1 January 2014 to 31 December 2019 were involved and followed until the occurrence of CVE, change to hemodialysis or kidney transplantation, loss to follow-up, death, or till the study termination date (31 December 2021). According to the changes in dialysate to plasma ratio of creatinine at 4h(4hD/Pcr), all participants were divided into increased (n=70) or decreased (n=44) groups. Compared the occurrence of CVE between the two groups and used the COX regression to explore the influencing factors of CVE in PD patients. Results In patients with baseline peritoneal transport functions were low transporters, 4hD/Pcr tended to increase in the first two years, low average transporters increased in the first year, and both high and high average transporters showed a decreasing trend in the first two years. The patients in increased group were significantly younger than the decreased group (t=2.396, P=0.018). A total of 44 (38.6%) patients developed CVE during a mean follow-up of 40.5 months. Among them, 22 (31.4%) were in the increase group and 22 (50%) were in the decrease group. The cumulative proportion of CVE-free in the increased group was higher than that in the decreased group (χ2=4.000, P=0.046). Multivariate Cox regression analysis showed that the changes in 4hD/Pcr (HR=0.093, 95%CI: 0.013～0.662, P=0.018) and diabetes mellitus (HR=2.824, 95%CI: 1.441～5.535, P=0.002) were independent influencing factors for the occurrence of CVE in PD patients. Conclusion PD patients with decreased 4hD/Pcr have a high risk of CVE.
[1] Twardowski Z J. Clinical value of standardized equilibration tests in CAPD patients [J]. Blood purification, 1989, 7(2-3): 95-108.
[2] Hung K Y, Huang J W, Tsai T J, et al. Natural changes in peritoneal equilibration test results in continuous ambulatory peritoneal dialysis patients: a retrospective, seven year cohort survey [J]. Artificial organs, 2000, 24(4): 261-4.
[3] Krediet R T, Balafa O. Cardiovascular risk in the peritoneal dialysis patient [J]. Nature reviews Nephrology, 2010, 6(8): 451-60.
[4] Devereux R B, Alonso D R, Lutas E M, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings [J]. The American journal of cardiology, 1986, 57(6): 450-8.
[5] Li P K, Szeto C C, Piraino B, et al. ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment [J]. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 2016, 36(5): 481-508.
[6] Mou S, Wang Q, Fang W, et al. Change in cardiovascular disease status in peritoneal dialysis patients: a 5-year single-center experience [J]. Renal failure, 2012, 34(1): 28-34.
[7] Zhang D, Yang Y, Li R, et al. Comparison of long-term outcomes between Chinese peritoneal dialysis patients with and without diabetes: A 10-year cohort study [J]. Journal of diabetes and its complications, 2021, 35(5): 107888.
[8] Sezer S, Tutal E, Arat Z, et al. Peritoneal transport status influence on atherosclerosis/inflammation in CAPD patients [J]. Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation, 2005, 15(4): 427-34.
[9] Kang D H, Yoon K I, Choi K B, et al. Relationship of peritoneal membrane transport characteristics to the nutritional status in CAPD patients [J]. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 1999, 14(7): 1715-22.
[10] Gillerot G, Goffin E, Michel C, et al. Genetic and clinical factors influence the baseline permeability of the peritoneal membrane [J]. Kidney Int, 2005, 67(6): 2477-87.
[11] Teng L, Chang M, Liu S, et al. Peritoneal microvascular endothelial function and the microinflammatory state are associated with baseline peritoneal transport characteristics in uremic patients [J]. Int Urol Nephrol, 2015, 47(1): 191-9.
[12] Honda K, Hamada C, Nakayama M, et al. Impact of uremia, diabetes, and peritoneal dialysis itself on the pathogenesis of peritoneal sclerosis: a quantitative study of peritoneal membrane morphology [J]. Clinical journal of the American Society of Nephrology : CJASN, 2008, 3(3): 720-8.
[13] Sánchez-Villanueva R, Bajo A, Del Peso G, et al. Higher daily peritoneal protein clearance when initiating peritoneal dialysis is independently associated with peripheral arterial disease (PAD): a possible new marker of systemic endothelial dysfunction? [J]. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2009, 24(3): 1009-14.
[14] Huang G, Wang Y, Shi Y, et al. The prognosis and risk factors of baseline high peritoneal transporters on patients with peritoneal dialysis [J]. Journal of cellular and molecular medicine, 2021, 25(18): 8628-44.
[15] Chung S H, Heimbürger O, Stenvinkel P, et al. Influence of peritoneal transport rate, inflammation, and fluid removal on nutritional status and clinical outcome in prevalent peritoneal dialysis patients [J]. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 2003, 23(2): 174-83.
[16] Paniagua R, Amato D, Vonesh E, et al. Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial [J]. Journal of the American Society of Nephrology : JASN, 2002, 13(5): 1307-20.
[17] Jiang C, Lo W K. Trend of peritoneal transport and impact on patient survival: A 10-year follow-up cohort study? [J]. Clinical nephrology, 2018, 89(5): 349-57.
[18] Chen J B, Pan H H, Lee C H, et al. Longitudinal change in peritoneal membrane function with continuous ambulatory peritoneal dialysis (CAPD) after peritonitis episodes [J]. Chang Gung medical journal, 2004, 27(1): 29-34.
[19] Chung S H, Heimbürger O, Stenvinkel P, et al. Association between inflammation and changes in residual renal function and peritoneal transport rate during the first year of dialysis [J]. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2001, 16(11): 2240-5.
[20] Davies S J. Longitudinal relationship between solute transport and ultrafiltration capacity in peritoneal dialysis patients [J]. Kidney Int, 2004, 66(6): 2437-45.
[21] Szeto C C, Chow K M, Poon P, et al. Genetic polymorphism of VEGF: Impact on longitudinal change of peritoneal transport and survival of peritoneal dialysis patients [J]. Kidney Int, 2004, 65(5): 1947-55.
