지속성 외래 복막투석 환자에서 이환율과 사망률의 예측인자로서 혈청 알부민의 의의

Abstract

Serum albumin(SA) is a powerful predictor of morbidity and mortality in hemodialysis(HD) population. In CAPD patients, SA may be more severely compromised because of large dialysate protein losses and lower protein intake relative to HD patients. Ho- wever, the usefulness of SA as a marker for incre- ased morbidity and mortality in CAPD patients remains undefined. To investigate the role of SA and ot- her risk factors as predictors of peritonitis, hospitalization and death in CAPD patients, we conducted this retrospective study on 782 patients who were followed-up for more than 3 months after initiation of CAPD at Severance Hospital from January 1985 through August 1995. For each patient the following data were collected: age, sex, duration on dialysis, presence of diabetes mellitus or cardiovascular dise- ase, and monthly biochemical data including SA. 1) The mean age of the patients was 45.5±13.6 years(range, 14-80) with sex ratio 1.2:1 and mean duration on dialysis was 30.8±25.6 months(range, 3- 122). 2) Independent factors affecting serum albumin level were creatinine( B =0.301, p<0.001), age( B =-0.216, p<0.001), hematocrit( B =0.184, p<0.001), DM( B =-0.176, p<0.007), triglyceride( B =0.114, p=0.002), BUN( B =0.095, p=0.021), total cholesterol( B =0.091, p=0.012), and card- iovascular disease( B =-0.075, p=0.023). 3) SA(B =-0.200, p<0.001), hematocrit(B =0.143, p<0.001), DM( B =0.108, p=0.007), cardiovascular disease(B=0.098, p=0.008), and old age(B=0.085, p= 0.044) were independent risk factors for hospitali- zation and only SA was an independent risk factor for peritonitis. 4) The independent predictors of mortality were DM(p<0.0001), hypoalbuminemia (p<0.0001), cardio- vascular disease(p=0.0001), and old age (p< 0.0001) in order. 5) The patients were divided into 3 groups according to the mean SA levels during the follow- up period(Group 1, SA<3,5g/ Dl; Group 2, 3.5g/Dl SA<4.0g/Dl; Group 3, SA>=4.0g/dL), and incidence of peritonitis, hospitalization and death were compared among them. Compared to group 2 and group 3, group 1 had significantly higher peritonitis rate(1.18 vs. 0.87, 0.66 times/year/patient, p<0.05) and hospi- talization(7.93 vs. 4.70, 3.36 days/year/patient, p<0.05). The 5- year survival rates in group 1, group 2 and group 3 were 43.4%, 60.9% and 84.1%, respectively (p<0.05). In conclusion, low SA is an important and strong predictor for morbidity and mortality in CAPD patients. Prospective studies are needed to determine if aggressive intervention with nutritional supplements could improve the SA level and to determine if such an improvement would impact on morbidity and mortality.