KT/V, NUTRITIONAL PARAMETERS, SERUM CORTISOL, AND INSULIN GROWTH-FACTOR-I LEVELS AND PATIENT OUTCOME IN HEMODIALYSIS

被引:29
作者
HIMMELFARB, J
HOLBROOK, D
MCMONAGLE, E
ROBINSON, R
NYE, L
SPRATT, D
机构
[1] MAINE MED CTR,DIV ENDOCRINOL,PORTLAND,ME 04102
[2] MAINE MED CTR,RES INST,PORTLAND,ME 04102
[3] SO MAINE DIALYSIS FACIL,PORTLAND,ME
关键词
HEMODIALYSIS; MORTALITY; KT/V; CORTISOL; INSULIN GROWTH FACTOR-I;
D O I
10.1016/S0272-6386(12)80904-8
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Despite many technical advances in dialysis care, morbidity and mortality in chronic hemodialysis patients in the United States remains high. In this study, we analyzed the effects of Kt/V, nutritional parameters (serum albumin level, triceps skin-fold thickness, mid-arm muscle circumference, and normalized protein catabolic rate), and predialysis serum cortisol and insulin growth factor-1 levels on predicting morbidity and mortality. The cohort studied consisted of 52 patients recruited from a single outpatient dialysis facility. Cox proportional hazards modeling indicated that only Kt/V predicted subsequent mortality (P = 0.02), while both predialysis cortisol levels (P = 0.03) and Kt/V (P = 0.03) predicted hospitalization. Kaplan-Meier analysis demonstrated that the ability of cortisol levels to predict hospitalization was largely confined to the group with values greater than 22 µLg/dL predialysis. High serum cortisol levels were correlated with low serum albumin levels and a trend toward low triceps skin-fold thickness and higher normalized protein catabolic rate, suggesting a catabolic state. Both predialysis serum cortisol and insulin growth factor-1 levels were higher than those in age- and sex-matched normal human controls. These results demonstrate the important role of Kt/V in predicting subsequent hospitalization rates and mortality, and that high predialysis serum cortisol levels correlate with a high hospitalization rate. © 1994, National Kidney Foundation. All rights reserved. All rights reserved.
引用
收藏
页码:473 / 479
页数:7
相关论文
共 36 条
[1]  
Acchiardo S R, 1983, Kidney Int Suppl, V16, pS199
[2]  
BIACHI R, 1978, AM J CLIN NUTR, V31, P1615
[3]   METHODS FOR ASSESSING NUTRITIONAL-STATUS OF PATIENTS WITH RENAL-FAILURE [J].
BLUMENKRANTZ, MJ ;
KOPPLE, JD ;
GUTMAN, RA ;
CHAN, YK ;
BARBOUR, GL ;
ROBERTS, C ;
SHEN, FH ;
GANDHI, VC ;
TUCKER, CT ;
CURTIS, FK ;
COBURN, JW .
AMERICAN JOURNAL OF CLINICAL NUTRITION, 1980, 33 (07) :1567-1585
[4]   NITROGEN-BALANCE DURING INTERMITTENT DIALYSIS THERAPY OF UREMIA [J].
BORAH, MF ;
SCHOENFELD, PY ;
GOTCH, FA ;
SARGENT, JA ;
WOLFSON, M ;
HUMPHREYS, MH .
KIDNEY INTERNATIONAL, 1978, 14 (05) :491-500
[5]   HORMONAL RESPONSES TO ACUTE VOLUME CHANGES IN ANEPHRIC SUBJECTS [J].
COOKE, CR ;
GANN, DS ;
WHELTON, PK ;
HSU, TH ;
BLEDSOE, T ;
MOORE, MA ;
WALKER, WG .
KIDNEY INTERNATIONAL, 1983, 23 (01) :71-78
[6]  
DAUGIRDAS JT, 1989, INT J ARTIF ORGANS, V12, P420
[7]   INSULIN RESISTANCE IN UREMIA [J].
DEFRONZO, RA ;
ALVESTRAND, A ;
SMITH, D ;
HENDLER, R ;
HENDLER, E ;
WAHREN, J .
JOURNAL OF CLINICAL INVESTIGATION, 1981, 67 (02) :563-568
[8]  
FELMAN HA, 1975, MEDICINE, V54, P345
[9]  
GOLDWASSER P, 1993, J AM SOC NEPHROL, V3, P1613
[10]  
GUTIERREZ A, 1992, CLIN NEPHROL, V38, P20