Background and objectives: Inflammation and malnutrition are important features in patients with ESRD; however, data on changes in these parameters over time are scarce. This study aimed to gain insight into changes over time in serum albumin, body mass index, high-sensitivity C-reactive protein, and IL-6 in patients with ESRD and aimed to identify clinical risk factors for deterioration of these parameters. Design, setting, participants, & measurements: Data were analyzed from the Convective Transport Study, a randomized controlled trial conducted from June 2004 to January 2011, in which 714 patients with chronic ESRD were randomized to either online hemodiafiltration or low-flux hemodialysis. Albumin and body mass index were measured up to 6 years and predialysis C-reactive protein and IL-6 were measured up to 3 years in a subset of 405 participants. Rates of change in these parameters over time were estimated across strata of predefined risk factors with linear mixed-effects models. Results: Albumin and body mass index decreased and C-reactive protein and IL-6 increased over time. For every incremental year of age at baseline, the yearly excess decline in albumin was 0.003 g/dl (-0.004 to -0.002; P0.001) and the excess decline in body mass index was 0.02 kg/m2 per year (-0.02 to -0.01; P0.001). In patients with diabetes mellitus, there was a yearly excess decline of 0.05 g/dl in albumin (-0.09 to -0.02; P=0.002). Compared with women, men had an excess decline of 0.03 g/dl per year in albumin (-0.06 to -0.001; P=0.05) and an excess increase of 11.6% per year in IL-6 (0.63%-23.6%; P=0.04). Conclusions: Despite guideline-based care, all inflammatory and nutritional parameters worsened over time. The deterioration of some of these parameters was more pronounced in men, older patients, and patients with diabetes mellitus. Special focus on the nutritional status of at-risk patients by individualizing medical care might improve their prognosis.
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机译：背景与目的：炎症和营养不良是ESRD患者的重要特征。但是，有关这些参数随时间变化的数据很少。这项研究旨在了解ESRD患者血清白蛋白，体重指数，高敏C反应蛋白和IL-6随时间的变化，并确定导致这些参数恶化的临床危险因素。设计，设置，参与者和测量：数据来自对流运输研究，该研究于2004年6月至2011年1月进行了一项随机对照试验，其中714例慢性ESRD患者被随机分为在线血液透析滤过或低通量血液透析。在405名参与者中，测量了长达6年的白蛋白和体重指数，并且测量了长达3年的透析前C反应蛋白和IL-6。这些参数随时间的变化率是通过线性混合效应模型跨预定义的风险因素分层估算的。结果：白蛋白和体重指数随时间降低，C反应蛋白和IL-6升高。在基线每增加一个年龄，白蛋白的年度过量下降为0.003 g / dl（-0.004至-0.002; P <0.001），而体重指数的过量下降为每年0.02 kg / m2（-0.02至-0.01; P <0.001）。在糖尿病患者中，白蛋白每年过量下降0.05 g / dl（-0.09至-0.02; P = 0.002）。与女性相比，男性白蛋白每年过量降低0.03 g / dl（-0.06至-0.001; P = 0.05），IL-6每年过量升高11.6％（0.63％-23.6％; P = 0.04）。结论：尽管有基于指南的护理，但所有炎症和营养参数随时间而恶化。这些参数中某些参数的恶化在男性，老年患者和糖尿病患者中更为明显。通过个性化的医疗护理来特别关注高危患者的营养状况可能会改善他们的预后。
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