IMPACT OF RESIDUAL RENAL FUNCTION ON CHANGES OF BODY COMPOSITION IN DIABETIC CAPD PATIENTS

摘要

Purpose: Preservation of residual renal function (RRF) in peritoneal dialysis patient is essential to improve clinical outcomes. Therefore, we conducted a prospective observational study to investigate the effect of low RRF in early period on body composition changes in CAPD patients. Methods: Among new diabetic CAPD patients from May 2001 to December 2009 in our hospital, 92 patients who finished 12 month protocol (male: 48, mean age: 54.0+/-11.0 years) were analyzed. Patients were assigned to 4 different dialysis solution (Dianeal^(R)n=30, Physioneal^(R)n=15 and Stay-safe^(R)n=15, Stay-safe.Balance^(R), n=32). We defined the early low RRF group (n=10) as less than 1.5ml/min 1.73m^2 at 4 weeks after initiation of peritoneal dialysis. Daily ultrafiltration volume (UFV) and urine volume (UV), daily peritoneal glucose absorption, adequacy, residual renal function (RRF) and clinical indices were measured at 4 weeks and 12 months. The peritoneal equilibration test (PET) were performed at 4 weeks and 12 months. Body composition including body weight (BW), lean body mass (LBM) and fat mass were measured using bio-impedance analysis (BIA) at 4 weeks and 12 months. Delta LBM was calculated as LBM at 12 months minus LBM at 4 weeks. We analyzed the data by SPSS 17.0. Results: 1) Baseline characteristics between the early low RRF group and the non-early low RRF group were not significantly different. 2) There was significant positive correlation between RRF at 4 weeks and RRF at 12 months (p<0.01). 3) The early low RRF group showed significant lower delta LBM than non-early low RRF group (-3.1vs. 0.95kg, p<0.05) There were no significant differences in body weight and fat mass between the two groups. 4) The early low RRF group showed significant lower serum albumin than non-early low RRF group (3.25vs. 3.59g/dl, p<0.05) at 12 months. Conclusions: The low RRF in early period of peritoneal dialysis might be associated with body composition changes during the first year in CAPD patients. It is suggested that preservation of RRF in early period of peritoneal dialysis is important to improve nutritional status.