中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (05): 382-386.doi: 10.3969/j.issn.1671-4091.2025.05.005

• 临床研究 • 上一篇    下一篇

蛋白摄入量对不同初始转运功能腹膜透析患者血磷的影响

王晓培   吕 晶   梁嫦娜   

  1. 710061 西安，1西安交通大学第一附属医院肾脏内科
  • 收稿日期:2024-06-11 修回日期:2025-02-18 出版日期:2025-05-12 发布日期:2025-05-12
  • 通讯作者: 吕晶 E-mail:drlvjing@163.com
  • 基金资助:
    陕西省自然科学基础研究计划项目(2022JM-598)；西安交通大学第一附属医院临床科研课题面上项目(XJTU1AF-CRF-2019-017)

Effect of protein intake on serum phosphorus in peritoneal dialysis patients with different initial solute transport characteristics

WANG Xiao-pei, LYU Jing, LIANG Chang-na   

  1. Department of Nephrology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
  • Received:2024-06-11 Revised:2025-02-18 Online:2025-05-12 Published:2025-05-12
  • Contact: 710061 西安，1西安交通大学第一附属医院肾脏内科 E-mail:drlvjing@163.com

摘要： 目的  横断面研究蛋白摄入量对不同腹膜转运功能腹膜透析(peritoneal dialysis,PD)患者血磷的影响，探讨预防高磷血症合理的蛋白摄入量。 方法  调查单中心透析1～3月的PD患者740例，根据腹膜平衡试验4小时透析液与血浆肌酐比值(dialysate to plasma ratio of creatinine at 4h，4hD/Pcr)分为快速转运组(4hD/Pcr＞0.65)和非快速转运组(4hD/Pcr≤0.65)。比较2组血磷，腹膜磷清除率，尿磷清除率，每日磷清除总量。根据计算的标准化蛋白分解率(normalized protein catabolic rate，nPCR)分为：A组[nPCR＜0.80 g/(kg·d)]、B组[nPCR 0.80～1.0 g/(kg·d)]和C组[nPCR≥1.0 g/(kg·d)]，比较2组患者在不同转运功能时的血磷，分析导致高磷血症的危险因素。 结果  快速转运组329人，非快速转运组411人。快速转运组患者血磷(t=6.279，P＜0.001)、尿磷清除总量(t=2.910，P=0.029)低于非快速转运组，腹膜磷清除率(t=-6.172，P＜0.001)、每日腹透液磷清除量(t=-3.403，P=0.001)高于非快速转运组。4hD/Pcr与腹膜磷清除率呈正比(r=0.393，P＜0.001)，与血磷呈反比(r=-0.245，P＜0.001)。非快速转运组患者血磷与nPCR呈正相关(r=0.237，P＜0.001)。曲线下面积0.635(95% CI：0.581～0.689，P＜0.001),截断值0.995 g/(kg·d)，敏感性54.4%，特异性78.5%。 结论  非快速转运腹膜透析患者，高蛋白饮食导致高磷血症的风险增加。非快速转运患者nPCR可预测透析初始月高磷血症；尿磷清除率和腹膜磷清除率对维持血清磷水平存在代偿现象。

关键词: 腹膜转运功能, 蛋白摄入量, 血磷

Abstract: Objective  To investigate the effects of protein intake on serum phosphorus levels in peritoneal dialysis (PD) patients with different peritoneal solute transport characteristics and to explore appropriate protein intake for preventing hyperphosphatemia in this cross-sectional study.  Method  A cohort of 740 patients with peritoneal dialysis (PD) who had been on dialysis for 1–3 months at a single center was included. Patients were categorized into rapid transporters (4h D/P Cr > 0.65) and non-rapid transporters (4h D/P Cr≤0.65) based on the 4-hour dialysate-to-plasma creatinine ratio (4h D/P Cr) from peritoneal equilibration tests (PET). Serum phosphorus, peritoneal phosphorus clearance, urinary phosphorus clearance, and total daily phosphorus clearance were compared between the two groups. Patients were further stratified by normalized protein catabolic rate (nPCR): Group A [nPCR ＜0.80 g/(kg·d)], Group B [nPCR 0.80～1.0 g/(kg·d)], and Group C [nPCR≥1.0 g/(kg·d)]. Serum phosphorus levels and risk factors for hyperphosphatemia were analyzed across transport categories.  Result  The cohort included 329 rapid transporters and 411 non-rapid transporters. Rapid transporters had lower serum phosphorus (t=6.279, P<0.001) and total urinary phosphorus clearance (t=2.910, P=0.029) but higher peritoneal phosphorus clearance (t=−6.172, P<0.001) and daily dialysate phosphorus removal (t=−3.403, P=0.001) compared to non-rapid transporters. The 4h D/P Cr was positively correlated with peritoneal phosphorus clearance (r=0.393, P<0.001) and inversely correlated with serum phosphorus (r=−0.245, P<0.001). In non-rapid transporters, serum phosphorus positively correlated with nPCR (r=0.237, P<0.001). The area under the ROC curve (AUC) was 0.635 (95% CI:0.581～0.689, P<0.001), with a cutoff nPCR of 0.995 g/(kg·d), yielding a sensitivity of 54.4% and a specificity of 78.5%.  Conclusion  High protein intake increases the risk of hyperphosphatemia in non-rapid transporters. nPCR predicts hyperphosphatemia during the initial months of dialysis in this subgroup. Urinary and peritoneal phosphorus clearance exhibit compensatory effects in maintaining serum phosphorus levels.

Key words: Peritoneal dialysis transport function, Protein intake, Serum phosphorus

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