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Value of peritoneal protein clearance as a predictor of cardiovascular outcomes in peritoneal dialysis patients
Niu Wei, Yang Xiaoxiao, Shen Yiwei, Ma Dahua, Xu Yimei, Song Qianhui, Yu Zanzhe, Yan Hao, Li Zhenyuan, Ni Zhaohui, Fang Wei
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Value of peritoneal protein clearance as a predictor of cardiovascular outcomes in peritoneal dialysis patients
Objective To investigate the predictive value of peritoneal protein clearance (Pcl) for cardiovascular events and cardiovascular mortality in peritoneal dialysis (PD) patients. Methods Eligible PD patients were prospectively enrolled from January 2014 to April 2015 in the PD Center of Renji Hospital, School of Medicine, Shanghai Jiao Tong University. All patients were followed up until death, withdrawing from PD, transferring to other centers, or the end of study period (October 1, 2018). The patients were divided into high Pcl group and low Pcl group by the median Pcl, and the differences of related indicators between the two groups were compared. A multiple linear regression model was used to analyze the influencing factors of Pcl. The Kaplan-Meier method and Log-rank test were used to compare the cumulative survival rates of patients between the two groups. A multivariate Cox regression model was used to estimate the risk of cardiovascular events and cardiovascular mortality in relation to Pcl in PD patients. Results A total of 271 patients were enrolled, with 135 males (49.8%), age of (56.92±0.84) years old and a median PD duration of 38.77(19.00, 63.10) months. There were 70 patients (25.8%) comorbiding with diabetes and 81 patients (29.9%) with cardiovascular diseases (CVD). The median Pcl of this cohort was 67.93(52.31, 88.36) ml/d. Compared with the low Pcl group (Pcl<67.93 ml/d), the high Pcl group (Pcl≥67.93 ml/d) had older age, and greater proportion of CVD, body mass index (BMI), pulse pressure, brain natriuretic peptide, mass transfer area coefficient of creatinine (MTACcr), and lower serum albumin (all P<0.05). There was no significant difference in gender, dialysis duration, proportion of diabetes, proportion of angiotensin converting enzyme inhibitor and angiotensin receptor blocker, proportion of continuous ambulatory PD, high sensitivity C reactive protein, fluid removal including 24 h urine volume and 24 h ultrafiltration, and residual renal function between the two groups (all P>0.05). Multiple linear regression analysis showed that serum albumin (β=-0.388, P<0.001), BMI (β=0.189, P<0.001), and MTACcr (β=0.247, P<0.001) were independently related to lg(Pcl). During the study period, 55 patients experienced one or more cardiovascular events and 39 patients had cardiovascular mortality. According to Kaplan-Meier analysis, cardiovascular mortality in the high Pcl group was higher than that of low Pcl group (Log-rank χ2=6.902, P=0.009). Multivariate Cox regression analysis showed that, high lg(Pcl) was an independent influencing factor of cardiovascular events in PD patients (HR=7.654，95%CI 1.676-34.945, P=0.009). Conclusions Serum albumin, BMI and MTACcr are independently associated with Pcl, and Pcl is an independent predictor of cardiovascular events in PD patients.
Peritoneal dialysis / Cardiovascular diseases / Prognosis / Peritoneal protein clearance {{custom_keyword}} /
表1 两组患者临床指标、透析相关指标和实验室检查结果的比较 |
| 项目 | 总体 (n=271) | 低Pcl组 (Pcl<67.93 ml/d，n=136) | 高Pcl组 (Pcl≥67.93 ml/d，n=135) | 统计量 (t/Z/χ2) | P值 |
|---|---|---|---|---|---|
| Pcl(ml/d) | 67.93(52.31，88.36) | 52.31(43.53，59.35) | 88.36(76.46，103.27) | -14.230 | <0.001 |
| 年龄(岁) | 56.92±0.84 | 54.87±1.30 | 59.00±1.04 | -2.478 | 0.014 |
| 男性[例(%)] | 135(49.8) | 60(44.1) | 75(55.5) | 3.545 | 0.060 |
| BMI(kg/m2) | 22.57(20.57，25.44) | 21.83(20.10，24.90) | 23.56(21.21，26.12) | -3.519 | <0.001 |
| 透析龄(月) | 38.77(19.00，63.10) | 40.80(20.11，61.80) | 35.63(15.83，63.97) | -0.933 | 0.351 |
| 合并糖尿病[例(%)] | 70(25.8) | 32(23.5) | 38(28.1) | 0.754 | 0.385 |
| 合并CVD[例(%)] | 81(29.9) | 32(23.5) | 49(36.3) | 5.270 | 0.022 |
| ACEI/ARB[例(%)] | 152(56.0) | 70(51.4) | 82(60.7) | 2.364 | 0.124 |
| CAPD[例(%)] | 227(83.7) | 115(84.5) | 112(82.9) | 0.127 | 0.722 |
| 脉压差(mmHg) | 52(42，62) | 50(39，57) | 56(45，67) | -3.987 | <0.001 |
| 血清白蛋白(g/L) | 37.69±0.25 | 39.26±0.31 | 36.10±0.35 | 6.851 | <0.001 |
| hsCRP(mg/L) | 2.37(0.80，6.37) | 2.00(0.71，5.92) | 2.69(0.84，6.54) | -0.653 | 0.514 |
| BNP(ng/L) | 79.0(36.0，164.0) | 56.5(27.3，107.0) | 124.0(58.0，291.0) | -5.785 | <0.001 |
| 24 h尿量(ml/d) | 200(0，600) | 200(0，638) | 250(0，600) | -0.761 | 0.447 |
| 24 h超滤量(ml/d) | 575(190，900) | 573(250，888) | 590(175，900) | -0.167 | 0.867 |
| 残余肾功能(ml/min) | 0.60(0，2.36) | 0.57(0，2.29) | 0.60(0，2.47) | -0.579 | 0.563 |
| MTACcr(ml/min) | 7.43(5.85，9.48) | 6.84(5.48，8.21) | 8.33(6.55，11.32) | -5.049 | <0.001 |
| 注：Pcl：腹膜蛋白清除率；BMI：体重指数；CVD：心血管疾病；ACEI/ARB：血管紧张素转换酶抑制剂和血管紧张素受体拮抗剂；CAPD：持续性非卧床腹膜透析；1 mmHg=0.133 kPa；hsCRP：超敏C反应蛋白；BNP：脑钠肽；MTACcr：肌酐的物质转运面积系数；数据形式除已注明外，呈正态分布的计量资料以 |
表2 腹膜蛋白清除率的相关影响因素（多元线性回归分析，n=271） |
| 指标 | 未标准化系数B | 标准误 | 标准化系数β | P值 |
|---|---|---|---|---|
| 血清白蛋白(g/L) | -0.018 | 0.003 | -0.388 | <0.001 |
| 体重指数(kg/m2) | 0.010 | 0.003 | 0.189 | <0.001 |
| MTACcr(ml/min) | 0.014 | 0.003 | 0.247 | <0.001 |
| 注：MTACcr：肌酐的物质转运面积系数；Pcl作以10为底的对数转化，校正年龄、性别、合并心血管疾病、脑钠肽和脉压差 |
表3 腹膜透析患者发生心血管疾病事件的影响因素（Cox比例风险回归模型，n=271） |
| 变量 | 单因素 | 多因素(模型1) | 多因素(模型2) | |||
|---|---|---|---|---|---|---|
| HR(95%CI) | P值 | HR(95%CI) | P值 | HR(95%CI) | P值 | |
| 年龄(岁) | 1.041(1.019~1.063) | <0.001 | ||||
| 男性(男性/女性) | 1.238(0.728~2.106) | 0.430 | ||||
| BMI(kg/m2) | 1.046(0.983~1.114) | 0.158 | ||||
| 合并CVD(是/否) | 3.811(2.228~6.519) | <0.001 | 3.454(2.016~5.918) | <0.001 | 3.262(1.875~5.673) | <0.001 |
| 合并糖尿病(是/否) | 1.607(0.922~2.801) | 0.095 | ||||
| lg(Pcl) | 9.517(2.453~36.928) | 0.001 | 7.654(1.676~34.945) | 0.009 | ||
| Pcl分组(高Pcl组/低Pcl组) | 1.727(1.002~2.976) | 0.049 | ||||
| 血清白蛋白(g/L) | 0.897(0.842~0.955) | 0.001 | 0.927(0.869~0.989) | 0.023 | ||
| lg(MTACcr) | 1.019(0.201~5.173) | 0.982 | ||||
| hsCRP(ng/L) | 1.007(0.987~1.027) | 0.484 | ||||
| 脉压差(mmHg) | 1.011(0.994~1.028) | 0.202 | ||||
| 注：BMI：体重指数；CVD：心血管疾病；Pcl：腹膜蛋白清除率，单位为ml/d；MTACcr：肌酐的物质转运面积系数；hsCRP：超敏C反应蛋白；1 mmHg=0.133 kPa；HR：风险比；CI：置信区间；模型 1：纳入连续变量lg（Pcl），校正年龄、性别、BMI、血清白蛋白、合并糖尿病和CVD；模型 2：纳入分类变量Pcl分组，校正年龄、性别、BMI、血清白蛋白、合并糖尿病和CVD |
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Technical innovations in peritoneal dialysis (PD), now used widely for the long-term treatment of ESRD, have significantly reduced therapy-related complications, allowing patients to be maintained on PD for longer periods. Indeed, the survival rate for patients treated with PD is now equivalent to that with in-center hemodialysis. In parallel, changes in public policy have spurred an unprecedented expansion in the use of PD in many parts of the world. Meanwhile, our improved understanding of the molecular mechanisms involved in solute and water transport across the peritoneum and of the pathobiology of structural and functional changes in the peritoneum with long-term PD has provided new targets for improving efficiency and for intervention. As with hemodialysis, almost half of all deaths on PD occur because of cardiovascular events, and there is great interest in identifying modality-specific factors contributing to these events. Notably, tremendous progress has been made in developing interventions that substantially reduce the risk of PD-related peritonitis. Yet the gains have been unequal among individual centers, primarily because of unequal clinical application of knowledge gained from research. The work to date has further highlighted the areas in need of innovation as we continue to strive to improve the health and outcomes of patients treated with PD.Copyright © 2016 by the American Society of Nephrology.
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Cardiovascular (CV) death is the most frequent cause of dying in peritoneal dialysis (PD) patients. Risk factors include not only those that can be present in the general population, but also those related to the presence of end-stage renal disease (ESRD) and factors that are specific for PD modality. Hypertension is the most important general risk factor in PD patients, while obesity remains controversial. Inflammation, malnutrition, calcifications and probably endothelial dysfunction and oxidative stress are all CV risk factors present in ESRD that contribute to mortality in PD patients. Additional CV risk factors in PD are related to the glucose load, leading to increasing insulin resistance and a more atherogenic lipid profile. The presence of glucose degradation products in conventional dialysis solutions is mainly related to the development of peritoneal abnormalities, but not directly to cardiovascular disease. Loss of residual renal function and ultrafiltration failure promote overhydration, which is the most important PD-related risk factor for CV disease.
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| [4] |
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| [5] |
<i>Background:</i> Peritoneal protein excretion (PPE) is a potential marker of the outcome in peritoneal dialysis (PD) patients. <i>Method:</i> Observational study of a cohort of 269 patients starting PD in a single unit. Study variables: total PPE during a baseline peritoneal equilibration test (PET; PET-PPE) and 24-hour PPE. Control variables: essential baseline demographic, laboratory and adequacy markers. Main outcomes: mortality, cardiovascular events and risk of peritonitis. We applied univariate and multivariate strategies of survival analysis. <i>Main Results:</i> PET-PPE sustained a significant, yet limited correlation with 24-hour PPE (r = 0.46, p < 0.0005). At baseline, the main study variables showed an independent correlation with peritoneal transport characteristics (D/P<sub>240’</sub> creatinine) and cardiovascular comorbidity. PET-PPE (p < 0.0005, model global χ<sup>2</sup> 59.4) was a more accurate predictor of overall mortality than 24-hour PPE (p = 0.04, χ<sup>2</sup> 50.5). Moreover, PPE during PET, but not 24-hour PPE, was an independent predictor of the risks of cardiovascular and infectious mortality, and of peritonitis. <i>Conclusions:</i> Baseline PPE represents a strong independent marker of survival of PD patients. Estimation of PPE during PET is more accurate than 24-hour PPE for this purpose, sustains a definite independent association with cardiovascular and infectious mortality, and shows a significant correlation with the risk of peritonitis.
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Faster peritoneal transport has been associated with an increased risk of therapy failure and patient mortality. However, faster transport can the result of many factors. Peritoneal protein clearance (PPC) has been proposed to distinguish faster peritoneal transport attributable to inflammatory conditions, as protein clearance reflects large-pore flow, which increases during inflammation. We followed a cohort of 300 peritoneal dialysis patients, and after adjustments for age and comorbidity, higher PPC was associated with increased risk of death (hazard ratio: 1.81; 95% confidence interval: 1.11 to 2.95), even after patients underwent transplantation or transferred to hemodialysis.
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Peritoneal protein clearance has been suggested to be a marker of peritoneal inflammation and systemic endothelial dysfunction.We enrolled 711 consecutive incident PD patients. Baseline peritoneal protein clearance and other clinical information were reviewed. All patients were followed for at least 1 year for all-cause and cardiovascular mortality.The average PD effluent protein loss was 6.41 ± 2.16 g/day; peritoneal protein clearance was 97.15 ± 41.55 mL/day. The average duration of follow-up was 50.8 ± 36.2 months. Multivariate linear regression analysis showed that serum albumin, C-reactive protein, and mass transfer area coefficients of creatinine were independently associated with peritoneal protein clearance. By multivariate Cox regression analysis, age, Charlson comorbidity score, volume of overhydration and peritoneal protein clearance were independent predictors of all-cause mortality. Every 10 mL/day increase in peritoneal protein clearance confers 10.4% increase in risk of all-cause mortality (95% confidence interval 2.6-18.7%, p = 0.008). Peritoneal protein clearance was also associated with cardiovascular mortality by univariate analysis, but the association became insignificant after adjusting for confounding factors Cox regression analysis.Baseline peritoneal protein clearance is an independent predictor of all-cause mortality in incident PD patients. Routine measurement of peritoneal protein clearance may facilitate patient risk stratification.
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Aim: High peritoneal transport status is a determinant of morbidity and mortality in peritoneal dialysis (PD) patients. It was hypothesized that 24 h peritoneal albumin leakage predicted 2 year prospective cardiovascular outcome and survival in patients receiving PD.
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Peritoneal clearance of albumin—unlike the transport of small molecules—is defined by both vascular surface area and size-selective permeability. Few studies have supported a positive correlation between peritoneal albumin loss and mortality. The aim of this study was to investigate whether baseline peritoneal loss and clearance of albumin and other proteins is a risk factor of death in peritoneal dialysis patients.
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It is not clear whether the association of increased peritoneal protein clearance (PPCl) with worse survival on peritoneal dialysis (PD) is a consequence of either local or systemic inflammation or indicative of generalized endothelial dysfunction associated with comorbidity. To investigate this we determined the relationship of PPCl to comorbidity, membrane area (equivalent to low molecular weight peritoneal solute transport rate), local and systemic inflammation and hypoalbuminaemia, and for each of these with patient survival. 257 incident patients from three GLOBAL Fluid Study centers were included in this analysis. Clinical profiles were collected at baseline along with a peritoneal equilibration test, 24-h dialysate protein and paired plasma and dialysate cytokine measurements. Although peritoneal protein clearance was associated with increased age and severe comorbidity on univariate analysis, only dialysate IL-6, peritoneal solute transport rate, plasma albumin and cardiac comorbidities (ischaemic heart disease and left ventricular dysfunction) were independent explanatory variables on multivariate analysis. While peritoneal protein clearance and daily peritoneal protein loss were associated with survival in univariate analysis, on multivariate analysis only plasma IL-6, age, residual kidney function, comorbidity, and plasma albumin were independent predictors. Peritoneal protein clearance is primarily a function of peritoneal membrane area and local membrane inflammation. The association with comorbidity and survival is predominantly explained by its inverse relationship to hypoalbuminaemia, especially in diabetics.
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Background To examine serum angiopoietin-2 (Angpt-2) in relation to malnutrition, inflammation, atherosclerosis and cardiac valvular calcification, so-called MIAC syndrome and its predictive role in outcomes of peritoneal dialysis (PD) patients.Methods A prospective observational study was conducted in 324 chronic PD patients. Biochemical analysis was performed at baseline for serum angiopoietins, albumin and high sensitive C-reactive protein (hs-CRP) and echocardiography was done to detect cardiac valvular calcification. Primary study end points were fatal or nonfatal cardiovascular events and mortality.Results The median of serum Angpt-2 levels was 5.44ng/mL (interquartile range, 3.41-7.85). Across the three tertiles of serum Angpt-2, a significant trend effect was observed for body mass index, normalized protein catabolic rate, calciumxphosphorus product, hs-CRP, brain natriuretic peptide, lower-density lipoprotein cholesterol, left ventricular ejection fraction, total weekly urea clearance and residual renal function (all p<0.05). Serum Angpt-2 showed a significant increase across the four groups of patients with increasing components of MIAC syndrome (p<0.001). There were 77 deaths and 57 cardiovascular events. High serum Angpt-2 was an independent predictor of fatal and nonfatal cardiovascular events in PD patients (p=0.02), however serum Angpt-2 was not an independent predictor of all-cause mortality (p=0.3).Conclusions Serum Angpt-2 showed close association with valvular calcification, atherosclerosis, inflammation and malnutrition, having significant independent prognostic value and is useful for cardiovascular event stratification in chronic PD patients. Angpt-2 might be a potential mediator of increased cardiovascular risk in patients undergoing PD treatment.
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Peritonitis before peritoneal dialysis (PD) training (pretraining peritonitis [PTP]) is an uncommon event. The study aim was to examine the causative organisms, clinical outcomes, risk factors, and long-term consequences of PTP.
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Peritoneal protein loss (PPL) through peritoneal effluent has been a well-recognized detrimental result of peritoneal dialysis (PD) treatment since its inception. Investigation has focused mainly on PPL quantitative and qualitative determinations and evaluation of its prognostic value.
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Hypoalbuminemia and hyperfibrinogenemia are frequently observed in patients with chronic renal failure (CRF) and are both associated with cardiovascular diseases. The mechanisms responsible for hypoalbuminemia and hyperfibrinogenemia in CRF are unknown.In the present study, both albumin and fibrinogen kinetics were measured in vivo in predialysis patients (N = 6), patients on peritoneal dialysis (N = 7) and control subjects (N = 8) using l-[1-13C]-valine.Plasma albumin concentration was significantly lower in patients on peritoneal dialysis compared to control subjects (P < 0.05). Plasma fibrinogen was significantly increased in both predialysis patients (P < 0.01) as well as patients on peritoneal dialysis (P < 0.001) in comparison to control subjects. In contrast to albumin, fibrinogen is only lost in peritoneal dialysate and not in urine. The absolute synthesis rates (ASR) of albumin and fibrinogen were increased in patients on peritoneal dialysis (ASR albumin, 125 +/- 9 mg/kg/day versus 93 +/- 9 mg/kg/day, P < 0.05; ASR fibrinogen, 45 +/- 4 mg/kg/day versus 29 +/- 3 mg/kg/day, P < 0.01) compared to control subjects. Albumin synthesis is strongly correlated with fibrinogen synthesis (r2 = 0.665, P < 0.0001, N = 21). In this study, the observed hypoalbuminemia in patients on peritoneal dialysis is likely not explained by malnutrition, inadequate dialysis, inflammation, metabolic acidosis, or insulin resistance. We speculate that peritoneal albumin loss is of relevance.Synthesis rate of albumin and fibrinogen are coordinately up-regulated. Both albumin and fibrinogen are lost in peritoneal dialysis fluid. To compensate protein loss, albumin synthesis is up-regulated, but the response, in contrast to predialysis patients, does not fully correct plasma albumin concentrations in peritoneal dialysis patients. The increase in fibrinogen synthesis introduces an independent risk factor for atherosclerosis, since plasma fibrinogen pool is enlarged.
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Microalbuminuria is a marker of systemic endothelial dysfunction. We hypothesize that peritoneal albumin excretion in peritoneal dialysis (PD) patients, which is conceptually analogous to microalbuminuria in nonuremic patients, can predict cardiovascular disease in new PD patients.
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<i>Objective:</i> To determine if the association between high peritoneal protein clearance (PrC) and increased all-cause mortality is explained by inflammation and volume overload in continuous ambulatory peritoneal dialysis patients. <i>Subjects and Methods:</i> A total of 216 incident patients were enrolled. Demographics, biochemistry, inflammatory and volume status, peritoneal transport rate, fluid and solute removal were collected at baseline. <i>Results:</i> The median PrC was 57.2 ml/day. A high PrC was associated with more severe inflammation and volume overload. Using a multivariate regression model, for every 1-ml/day increase in PrC, the adjusted HR was 1.06 (1.00–1.12; p = 0.046) for all-cause death adjusted for age, diabetes, hemoglobin and D/Pcr. The predictability of PrC for all-cause death remained the same or mildly changed after additionally adjusted for inflammatory and volume overload markers with HR of 1.07 (1.00–1.14; p = 0.043) and 1.05 (0.99–1.12; p = 0.08), respectively. <i>Conclusions:</i> Peritoneal PrC, although correlated with volume overload and inflammation, is largely an independent predictor of mortality.
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Peritoneal effluent from peritoneal dialysis (PD) patients contains proteins, mainly transported from the circulation through large pores in the venular part of the peritoneal micro-vessels. Hydrostatic convection is the major driver for peritoneal protein transport, although in PD there is additional diffusion. Consequently, venous pressure may have a role in peritoneal protein transport. The aim of the study was to investigate the importance of venous congestion on the magnitude of peritoneal protein clearance in incident PD patients using non-invasive measurements.
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Peritoneal protein clearance (PPCl) depends upon vascular supply and size selective permeability. Some previous reports suggested PPCl can distinguish fast peritoneal membrane transport due to local or systemic inflammation. However, as studies have been discordant, we wished to determine factors associated with an increased PPCl. Consecutive patients starting peritoneal dialysis (PD) who were peritonitis‐free were studied. Data included a baseline peritoneal equilibration test (PET), measurement of dialysis adequacy, 24‐h dialysate PPCl and body composition measured by multifrequency bioimpedance. 411 patients, mean age 57.2 ± 16.6 years, 60.8% male, 39.4% diabetic, 20.2% treated by continuous ambulatory peritoneal dialysis (CAPD) were studied. Mean PET 4‐h Dialysate/Serum creatinine was 0.73 ± 0.13, with daily peritoneal protein loss 4.6 (3.3–6.4) g, and median PPCl 69.6 (49.1–99.6) mL/day. On multivariate analysis, PPCl was most strongly associated with CAPD (β 0.25, P < 0.001), extracellular water (ECW)/total body water (TBW) ratio (β 0.21, P < 0.001), skeletal muscle mass index (β 0.21, P < 0.001), log N‐terminal brain natriuretic peptide (NT‐proBNP) (β 0.17, P = 0.001), faster PET transport (β 0.15, P = 0.005), and normalized nitrogen appearance rate (β 0.13, P = 0.008). In addition to the longer dwell times of CAPD, greater peritoneal creatinine clearance and faster PET transporter status, we observed an association between increased PPCl and ECW expansion, increased NT‐proBNP, estimated dietary protein intake and muscle mass, suggesting a link to sodium intake and sodium balance, increasing both ECW and conduit artery hydrostatic pressure resulting in greater vascular protein permeability. This latter association may explain reports linking PPCl to patient mortality.
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Malnutrition is found frequently during chronic diseases, and its prevalence and relation to disease outcome in adult patients with congenital heart disease (CHD) remains unknown.A cohort of 393 consecutive stable congenital heart disease (CHD) patients was followed up in a single dedicated clinical unit. Demographic, clinical and laboratory parameters, along with a nutritional risk index (NRI), were studied, as well as major acute cardiovascular events (MACE), defined as arterial thrombotic events, heart failure requiring hospitalization or cardiovascular and non-cardiovascular mortality. The median age of the patients was 23 years (17-35) and 225 (57%) were males. Median plasma albumin concentration was 4.5 (4.2-4.7) g/dL, the body mass index was 23 (21-27) kg/m, the NRI was 112 (106-118), and 33 (8%) patients showed malnutrition (NIR<100). A worse NYHA functional class (II and III), total cholesterol and serum glucose levels were significant risk factors associated with malnutrition (NRI<100) in CHD patients. During a median follow-up of 8 (5-10) years, 39 (10%) CHD patients suffered a MACE. Multivariable Cox regression analysis showed that older patients (years) [HR 1.06 (1.04-1.09), p < 0.001], CHD patients with great anatomical complexity [HR 4.24 (2.17-8.27), p < 0.001] and those with a lower NRI [HR 0.95 (0.93-0.98), p = 0.001] had a significant worse MACE-free survival, being the NRI a better predictor of MACE than albumin concentration.A low NRI is independently associated with a significant increased risk of MACE in CHD patients.Copyright © 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
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PDF(1181 KB)
图1 腹膜透析患者筛选、分组和预后流程图
表1 两组患者临床指标、透析相关指标和实验室检查结果的比较图2 肌酐的物质转运面积系数与腹膜蛋白清除率的关系（散点图，n=271）表2 腹膜蛋白清除率的相关影响因素（多元线性回归分析，n=271）图3 高腹膜蛋白清除率（Pcl）组和低Pcl组腹膜透析患者累积无心血管事件比例和累积无心血管事件生存率的比较（Kaplan-Meier生存曲线）表3 腹膜透析患者发生心血管疾病事件的影响因素（Cox比例风险回归模型，n=271）/
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