残余肾功能对维持性血液透析病人营养状态的影响评估∗

摘要

目的：评估残余肾功能( RRF)对维持性血液透析病人营养状态的影响。方法：稳定维持性血液透析至少2年,共36例进入临床实验,连续7 d收集病人尿液以评估( RRF)。对营养参数包括体脂百分比,无脂肪参数,血清白蛋白浓度和标准化蛋白代谢率进行检测。结果：总共36例参试病人中,平均每周总尿素氮Kt/V为4.9,肾脏尿素氮Kt/V为0.7, RRF和血清白蛋白浓度显著正相关。随访1年后,按照残余肾功能将病人分为两组并对各种营养参数重新检测：残余尿量超过200 ml/d(平均650 ml；范围200~1500 ml),n=20为保留残余肾功能组；基本无尿病人(平均50 ml；范围0~200 ml),n=16为无残余肾功能组。在实验开始阶段,残余肾功能组病人平均血清白蛋白浓度和平均标准化蛋白代谢率分别为3.88 g/dl和1.15 g·kg-1·d-1,显著高于无残余肾功能组病人(P<0.05),但是对于两组病人,总(肾脏+透析)尿素氮Kt/V基本持平。在1年的实验期间,两组病人总尿素氮 Kt/V无显著性变化。对于残余肾功能组病人,平均血清白蛋白浓度增加至4.12 g/dl,但是对于无残余肾功能组病人,平均血清白蛋白浓度无显著性变化(从3.78~3.72 g/dl),同样,其他几组参数也观察到类似的趋势。结论：部分维持性血液透析病人仍有充分的残余肾功能,残余肾功能对患者整体营养参数产生有益的影响。%Objective:The residual renal function ( RRF) in chronic HD patients was studied to assess its influence on pa-tients’ nutritional status. Methods:In 36 chronic HD patients with at least a 2-year history of HD treatment, RRF was determined for 7 consecutive days. Nutritional parameters include percentage body fat, fat-free mass index, serum albumin and normalized pro-tein catabolic rate were measured. Results:In 36 patients, mean weekly total Kt/V urea was 4. 9 and renal Kt/V urea was 0. 7. RRF was well correlated with serum albumin concentration. After one year, RRF and nutritional indices were re-examined and patients were classified into two groups:with RRF, residual renal diuresis over 200 ml/day ( mean, 650 ml;range, 200~1 500 ml) , n=20;and without RRF, persistent anuria (mean, 50 ml;range, 0~200 ml), n=16. At the start of this study, the mean serum albumin concentration and mean normalized protein catabolic rate in patients with RRF were 3. 88 g/dl and 1. 15 g·kg-1 ·d-1 , respectively, which were significantly higher than those in patients without RRF (P<0. 05), while total (renal+dialysis) Kt/V urea were equal in both groups. During the 1-year study period, there was no significant change in total Kt/V urea in either group. Mean serum albu-min concentration increased to 4. 12 g/dl in patients with RRF, but did not change significantly (from 3. 78 to 3. 72 g/dl). The same trend was observed in all other parameters. Conclusion:Some of our HD patients had sufficient RRF. RRF itself may have a benefi-cial effect on nutritional parameters.