目的 分析残余肾功能(residual renal function,RRF)对血液透析患者营养状况及生活质量的影响。 方法 选取血液透析患者67例，将患者透析前24h内尿量≥200 ml/d分为有RRF组、尿量＜200ml/d为无RRF组，收集患者临床资料，比较血浆白蛋白、前白蛋白、骨骼肌指数等营养指标；按年龄将2组患者进一步分为青年组(18～＜45岁)、中年组(45～＜60岁)和老年组(≥60岁)亚组，利用简明健康调查量表(the MOS 36 item short form health survey,SF-36)评估对应亚组患者的生活质量。 结果 ①有RRF组(n=27)患者血浆前白蛋白水平(t=2.167,P=0.034)及骨骼肌指数(t=4.131,P＜0.001)优于无RRF组(n=40)；②具有RRF的青年组(n=8)及老年组(n=7)生理职能(青年组：t=4.781,P＜0.001，老年组：t=2.306,P=0.036)、情感功能(青年组：t=3.606,P=0.005，老年组：t=2.542,P=0.023)、精神健康(青年组：t=2.621,P=0.026，老年组：t=2.518,P=0.024)、精力(青年组：t=4.111,P=0.002，老年组：t=2.165, P=0.047)和社会功能(青年组：t=3.308,P=0.008，老年组：t=2.136,P=0.049)等5个维度SF-36评分均高于无RRF组青年组(n=9)及老年组(n=19)，躯体疼痛评分(青年组：t=3.400,P=0.007，老年组：t=2.439, P=0.028)低于无RRF组；而有RRF的中年组(n=12)较无RRF的中年组(n=12)患者精神健康(t=2.513, P =0.027)、精力(t=2.521,P =0.034)和社会功能(t=4.781,P =0.031)等3个维度SF-36评分更高，躯体疼痛评分(t=2.449,P=0.025)较低。 结论 具有RRF血液透析患者营养状况更好；RRF可全方位提高青年人群及老年人群生活质量，而对中年人群生活质量的影响有限。
Objective To analyze the effects of residual renal function (RRF) on nutritional status and quality of life in maintenance hemodialysis (MHD) patients. Methods A total of 67 MHD patients were selected and divided into RRF group with urine volume ≥ 200 ml/d within 24h before dialysis and non-RRF group without urine volume < 200 ml/d. The clinical data of the two groups were collected and analyzed. Plasma albumin, prealbumin and skeletal muscle index were compared between the two groups. Patients in the two groups were further subdivided into young subgroup (18～＜45 years old), middle-age subgroup (45～60 years old) and elderly subgroup (≥60 years old). The MOS 36 item Short Form Health Survey (SF-36) was used to evaluate the quality of life of the subgroups. Results ①The plasma prealbumin level (t=2.167, P=0.034) and skeletal muscle index (t=4.131, P＜0.001) were better in the RRF group than in the non-RRF group. ②The SF-36 scores of physiological function (t=4.781, P＜0.001 for young subgroups; t=2.306, P=0.036 for elderly subgroups), emotional function (t=3.606, P=0.005 for young subgroups; t=2.542, P=0.023 for elderly subgroups), mental health (t=2.621, P=0.026 for young subgroups; t=2.518, P=0.024 for elderly subgroups), energy (t=4.111, P=0.002 for young subgroups; t=2.165, P=0.0473 for elderly subgroups) and social function (t=3.308, P=0.008 for young subgroups; t=2.136, P=0.049 for elderly subgroups) were higher, and the scores of physical pain (t=3.400, P=0.007 for young subgroups; t=2.439, P=0.028 for elderly subgroups) were lower in the young and elderly subgroups of the RRF group than in the young and elderly subgroups of the non-RRF group. The SF-36 scores of mental health (t=2.513, P=0.027), energy (t=2.521, P=0.034) and social functioning (t=4.781, P=0.031) were higher, and the physical pain scores (t=2.449, P=0.025) were lower in the middle-age subgroup of the RRF group than in the middle-age subgroup of the non-RRF group. Conclusion The nutritional status was better in MHD patients with RRF. RRF can elevate the quality of life of all aspects in young and elderly people, but has limited influence on the quality of life in middle-age people.
[1] Nongnuch A, Assanatham M, Panorchan K, Davenport A. Strategies for preserving residual renal function in peritoneal dialysis patients. Clin Kidney J. 2015 Apr;8(2):202-11.
[2] Lindley E, Keane D, Belcher J, Fernandes Da Silva Jeffcoat N, Davies S. Monitoring residual kidney function in haemodialysis patients using timed urine collections: validation of the use of estimated blood results to calculate GFR. Physiol Meas. 2022 Aug 3;43(8).
[3] Daugirdas JT, Depner TA, Inrig J, Mehrotra R, Rocco MV, Suri RS, et al.; National Kidney Foundation. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update. Am J Kidney Dis. 2015 Nov;66(5):884–930.
[4] Lee MJ, Park JT, Park KS, Kwon YE, Oh HJ, Yoo TH, Kim YL, Kim YS, Yang CW, Kim NH, Kang SW, Han SH. Prognostic Value of Residual Urine Volume, GFR by 24-hour Urine Collection, and eGFR in Patients Receiving Dialysis. Clin J Am Soc Nephrol. 2017 Mar 7;12(3):426-434.
[5] Moist LM, Port FK, Orzol SM, et al. Predictors of loss of residual renal function among new dialysis patients [J]. Am Soc Nephrol, 2000,11(3):556
[6] Mathew AT, Fishbane S, Obi Y, Kalantar-Zadeh K. Preservation of residual kidney function in hemodialysis patients: reviving an old concept. Kidney Int. 2016;90(2):262–71.
[7] Li T, Wilcox CS, Lipkowitz MS, Gordon-Cappitelli J, Dragoi S. Rationale and Strategies for Preserving Residual Kidney Function in Dialysis Patients. Am J Nephrol. 2019;50(6):411-421.
[8] Ding L, Yang J, Li L, et al．Effects of ACEIs and ARBs on the residual renal function in peritoneal dialysis patients: a meta analysis of randomized controlled trials. Biomed Ｒes Int, 020, 2020: 6762029.
[9] Xydakis D, Papadogiannakis A, Sfakianaki M, Kostakis K, Stylianou K, Petrakis I, Ergini A, Voskarides K, Dafnis E. Residual renal function in hemodialysis patients: the role of angiotensin-converting enzyme inhibitor in its preservation. ISRN nephrology. 2013;2013:184527.
[10] Cravedi P, Remuzzi G, Ruggenenti P. Targeting the renin angiotensin system in dialysis patients. Semin Dial. 2011;24(3):290–7
[11] 钟波, 韦加美, 那宇. 残余肾功能对维持性血液透析病人营养状态的影响评估[J]. 中国中西医结合肾病杂志, 2016(3):4.
[12] Bataille S, Serveaux M, Carreno E, Pedinielli N, Darmon P, Robert A. The diagnosis of sarcopenia is mainly driven by muscle mass in hemodialysis patients. Clin Nutr. 2017 Dec;36(6):1654-1660.
[13] Morishita Y, Kubo K, Haga Y, et al. Skeletal muscle loss is negatively associated with single-pool Kt/V and dialysis duration in hemodialysis patients. Ther Apher Dial. 2014 Dec;18(6):612-7
[14] Ito K, Ookawara S, Hibino Y, Imai S, et al. Skeletal muscle mass index is positively associated with bone mineral density in hemodialysis patients. Front Med (Lausanne). 2020 May 15;7:187.
[15] Takata T, Mae Y, Yamada K, et al. Skeletal muscle mass is associated with erythropoietin response in hemodialysis patients. BMC Nephrol. 2021 Apr 16;22(1):134.
[16] Chiu LT, Wang CH, Lin YL, Hsu BG. Association of serum fibroblast growth factor 21 levels with skeletal muscle mass and mortality in chronic hemodialysis patients. J Formos Med Assoc. 2022 Dec;121(12):2481-2489.
[17] Kemp G.J., Crowe, A.V., Anijeet H.K., et al. Abnormal mitochondrial function and muscle wasting, but normal contractile efficiency, in haemodialysed patients studied non-invasively in vivo. Nephrol. Dial. Transplant. 2004, 19, 1520–1527.
[18] Tanriover C, Ucku D, Basile C, et al. On the importance of the interplay of residual renal function with clinical outcomes in end-stage kidney disease. J Nephrol. 2022 Dec;35(9):2191-2204.
[19] Cepeda Marte JL, Javier A, Ruiz-Matuk C, Paulino-Ramirez R. Quality of Life and Nutritional Status in diabetic patients on hemodialysis. Diabetes Metab Syndr. 2019 Jan-Feb;13(1):576-580.?
[20] Hiramatsu T, Okumura S, Asano Y, Mabuchi M, Iguchi D, Furuta S. Quality of life and emotional distress in peritoneal dialysis and hemodialysis patients. Ther Apher Dial. 2019;24(4):366–72.
[21] Elgendy A, Abdelsalam AI, Mansour M, Nassar MK. Can residual kidney function affect quality of life and cognitive function in hemodialysis patients? BMC Nephrol. 2022 Jul 23;23(1):263.
[22] 董洪, 于文慧. 残余肾功能与血液透析患者生活质量的相关性研究[J]. 天津医科大学学报, 2010 (3):488-491.
[23] 李丽, 郭晓娟. 维持性血液透析患者残余肾功能与生活质量的相关性[J]. 中国老年学, 2013, 33(5):1156-1157.
