糖尿病肾病和非糖尿病肾病腹膜透析患者容量负荷及营养状态分析

    Analysis of capacity load and nutritional status of peritoneal dialysis patients with diabetic kidney disease and non diabetic kidney disease

      摘要
    • 摘要: 目的 分析腹膜透析治疗1年内糖尿病肾脏疾病（diabetic kidney disease，DKD）和非糖尿病肾脏疾病（non-diabetic kidney disease，NDKD）患者容量负荷及营养状态相关指标变化情况，为更好的临床管理提供理论依据。方法 采用回顾性分析，收集2010年1月至2019年8月在上海中医药大学附属普陀医院肾内科接受腹膜透析（PD）治疗的116例患者（其中DKD组42例，NDKD组74例）的一般资料以及PD治疗模式、透析液浓度及剂量、24 h超滤量、24 h尿量、血压、水肿情况、服用降压药种类等临床资料，并收集PD治疗前及治疗1、3、6、12月后的肝功能、脑钠素（brain natriuretic peptide，BNP）等实验室检查指标，进行组内纵向比较及组间横向比较，明确PD治疗效果及两组间的疗效差异。结果 DKD组从透析1月起各时段PD治疗剂量均高于NDKD组（P<0.05），24 h PD超滤量则无显著性差异（P>0.05）；但透析12月后DKD组24 h尿量少于NDKD组（P<0.05），水肿发生率高于NDKD组（P<0.05），血压水平及服用降压药种类无显著性差异（P>0.05）；PD治疗后研究人群血清白蛋白（Alb）较基线值降低（P<0.05），DKD组从基线起至透析6月后Alb低于NDKD组（P<0.05），透析6月后两组间Alb水平未见显著性差异（P>0.05）。结论 DKD组较NDKD组在腹膜透析早期营养状态更差，透析12月后处于更高的容量负荷状态，透析1月后需要更大的PD治疗剂量，提示临床医生需根据患者体液潴留、血压和其他因素制定合理的PD方案以维持适当的血容量，保护患者残余肾功能。

       

      Abstract: Objective To analyze the changes of capacity load and nutritional status of diabetic kidney disease (DKD) and non diabetic kidney disease (NDKD) patients within one year of peritoneal dialysis,so as to provide theoretical basis for better clinical intervention.Methods The general data of 116 patients (42 in DKD group and 74 in NDKD group) who received peritoneal dialysis (PD) in our hospital from January 2010 to August 2019 were collected by retrospective analysis.The indexes of laboratory tests such as liver function and brain natriuretic peptide were measured at baseline and 1,3,6,12 months after PD;and clinical evaluation indexes such as peritoneal dialysis mode,dialysate concentration and dosage,24-hour ultrafiltration volume,24-hour urine volume,blood pressure,edema,and types of antihypertensive drugs were compared within a group and between groups by statistical tools,so as to clarify PD efficacy and the efficacy difference between the two groups.Results The dosage of peritoneal dialysis in the DKD group was higher than that in NDKD group (P<0.05) at various time points one month after dialysis.There was no significant difference in 24-hour peritoneal ultrafiltration volume (P>0.05),but 24-hour urine volume in the DKD group was less than that in the NDKD group (P<0.05),the incidence of edemat was higher than that of NDKD group (P<0.05) after 12 months of dialysis,but there was no significant difference in blood pressure level and types of antihypertensive drugs taken (P>0.05).After treatment,serum albumin (Alb) in the study population was lower than that at baseline (P<0.05),and Alb in the DKD group was lower than that in the NDKD group (P<0.05) from baseline to six months after dialysis.There was no significant difference between the two groups after six months(P>0.05).Conclusions The nutritional status in the DKD group is worse than that in the NDKD group at the early stage of dialysis.After 12 months of dialysis,the patients in the DKD group are in a higher capacity load condition than those in the NDKD group.After 1 month of dialysis,the DKD group needs a bigger peritoneal dialysis dosage than the NDKD group.This suggests that clinicians should make a reasonable peritoneal dialysis plan according to their body fluid retention,blood pressure and other factors to maintain an appropriate blood volume and protect residual renal functions.

       

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