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제목	Local Peritoneal Inflammation is Associated with Systemic Inflammation, Malnutrition, and All-cause Mortality in Peritoneal Dialysis Patients: A 3-year Prospective Study
저자	Kwang Il Ko, Chan Ho Kim, Fa Mee Doh, Hyang Mo Koo, Mi Jung Lee, Hyung Jung Oh,Seung Hyeok Han, Shin-Wook Kang, Kyu Hun Choi, Tae-Hyun Yoo
출판정보	2013; 2013(1):
키워드	복강 내 MCP-1, 염증, 사망률, 복막투석/Dialysate MCP-1, Inflammation, Mortality, Peritoneal dialysis
초록	Background: Systemic inflammation is known to be associated with patient survival in peritoneal dialysis (PD). Moreover, chronic inflammation is closely associated with malnutrition. A association between systemic inflammation and local peritoneal inflammation has yet to be confirmed. The aim of this study was to investigate the associations between local peritoneal inflammation, systemic inflammation, malnutrition, and all-cause mortality in PD patients. Methods: 169 PD patients were prospectively followed up from April 2008 to June 2011. At baseline, clinical and biochemical parameters such as age, sex, presence of diabetes, dialysate monocyte chemoattractant protein-1 (dMCP- 1), serum high sensitivity C-reactive protein (hs-CRP), serum albumin, and dialysate-to-plasma creatinine ratio (D/Pcr) were assessed. All-cause deaths and technique failures were evaluated during the study period. Based on the median level of dMCP-1, patients were classified as lower dMCP-1 group (n=85) and higher dMCP-1 group (n=84). Results: In higher dMCP-1 group, age, presence of diabetes, serum hs-CRP levels, and D/Pcr were higher, whereas serum albumin levels were significantly lower than lower dMCP-1 group. dMCP-1 levels were positively correlated with age, duration of peritoneal dialysis, D/Pcr, HbA1c, and serum hs-CRP, whereas inversely correlated with serum albumin levels. During the study period, 23 patients died. Time to patient survival was significantly longer in lower dMCP-1 group compared to higher dMCP-1 group (p=0.03). Cox proportional hazards multivariate analysis revealed that age, D/Pcr, and dMCP-1 were independent predictors of all-cause mortality. Conclusion: dMCP-1 level is significantly correlated with markers of systemic inflammation and malnutrition and a significant association with all-cause mortality in PD patients. These findings suggest that local peritoneal inflammation could be helpful to predict the mortality in PD patients.
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