The predictive and prognostic potential of serum parathyroid hormone combined with the nutritional status score on peritoneal dialysis catheter-related peritonitis

doi:10.3969/j.issn.1004-583X.2023.11.005

Abstract

Abstract:

Objective To investigate the effects of malnutrition and serum intact parathyroid hormone (iPTH) level on the incidence and prognosis of peritoneal dialysis catheter-related peritonitis. Methods A retrospective analysis was performed on hospitalized patients with uremia who underwent peritoneal dialysis catheterization in the Affiliated Hospital of Qingdao University from January 1, 2018 to April 30, 2022 and they were followed up until July 30, 2022. Kaplan-Meier survival curve and Cox regression were used to analyze the effects of iPTH and the Controlling Nutritional Status (CONUT) score on the occurrence and prognosis of peritoneal dialysis catheter-related peritonitis. Results A total of 193 patients with peritoneal dialysis were included in this study, with the mean age of (51.50±16.85) years old and 117 (60.6%) males. According to blood iPTH level and CONUT score, patients were divided into four groups. Forty-two cases (21.76%) presented low parathyroid hormone (iPTH<150 pg/ml, Hypo-PTH) combined with moderate-to-severe malnutrition (CONUT>4). There were significant differences in the distribution of chronic glomerulonephritis, lupus nephritis, diabetic nephropathy and the incidence of heart failure between groups ( $P$ <0.05). The largest number of patients treated with hormone or immunosuppressants was found in those with low parathyroid hormone and moderate-to-severe malnutrition. There were significant differences in age, hemoglobin, blood uric acid, C-reactive protein (CRP), B-type natriuretic peptide (BNP), blood sodium, blood calcium, blood phosphorus, albumin and globulin between groups ( $P$ <0.05). The highest incidence of peritonitis within 30 days after operation was 26.19% in patients with Hypo-PTH group and moderate-to-severe malnutrition. Cox regression analysis showed that this group had the highest risk of peritonitis, with a hazard ratio ( $H R$ ) of 5.206 (95% $C I$ 1.594, 17.002; $P$ =0.006). After adjusting for age, sex, BMI, hemoglobin, CRP, blood uric acid, BNP and other indicators, HR was still 5.187 (95% $C I$ 1.465, 18.360; $P$ =0.011). The incidence of poor prognosis was also significantly higher than that of the other three groups, with a $H R$ of 2.998 (95% $C I$ 1.328, 6.766; $P$ =0.008) and adjusted $H R$ of 2.665 (95% $C I$ 1.089, 6.522; $P$ =0.032). Conclusion The coexistence of hypoparathyroidism and moderate-to-severe malnutrition in patients with peritoneal dialysis is the risk factor for peritonitis after peritoneal dialysis catheterization, which can directly lead to the poor prognosis.

Key words: peritoneal dialysis, parathyroid hormone, peritonitis, nutrition

CLC Number:

R459.5

Gong Zhiqing, Lu Dongmei, Xing Guangqun. The predictive and prognostic potential of serum parathyroid hormone combined with the nutritional status score on peritoneal dialysis catheter-related peritonitis[J]. Clinical Focus, 2023, 38(11): 991-995.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.11.005

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I11/991

Figures/Tables 5

Tab.1 Comparison of general information between groups

项目	hypo-PTH		非hypo-PTH		$P$ 值
项目	CONUT>4分 ( $n$ =42)	CONUT≤4分 ( $n$ =25)	CONUT>4分 ( $n$ =59)	CONUT≤4分 ( $n$ =67)	$P$ 值
男性[例(%)]	27(64.3)	11(44.0)	34(57.6)	45(67.2)	0.208
年龄(岁)	54.48±17.77	50.92±20.11	55.86±14.52	46.00±15.63^*#	0.005
BMI(kg/m²)	22.94±4.49	23.85±3.73	24.81±4.47	24.14±4.12	0.189
原发病[例(%)]
慢性肾小球肾炎	3(7.1)	6(24.0)	18(30.5)^*	27(40.3)^*	0.002
糖尿病肾病	14(33.3)	5(20.0)	24(40.7)	9(13.4)^#	0.004
高血压肾病	4(9.5)	6(24.0)	7(11.9)	12(17.9)	0.333
狼疮性肾炎	9(21.4)	4(16.0)	3(5.1)^*	3(4.5)^*	0.011
其他病因	12(28.6)	4(16.0)	7(11.9)	16(23.9)	0.157
合并症[例(%)]
心力衰竭					0.035
NYHA心功能
Ⅰ-Ⅱ级	7(16.7)	3(12.0)	15(25.4)	6(9.0)
Ⅲ-Ⅳ级	13(30.9)	7(28.0)	17(28.8)	11(16.4)
无心力衰竭	22(52.4)	15(60.0)	27(45.8)	50(74.6)^#
除腹膜炎外其他部位的感染	12(28.6)	6(24.0)	11(18.6)	7(11.1)	0.089
乙肝或肝硬化	2(4.8)	1(4.0)	9(15.3)	11(16.4)	0.149
激素或免疫抑制剂使用[例(%)]	16(38.1)	5(20.0)	4(6.8)^*	6(9.0)^*	<0.01

Tab.1 Comparison of general information between groups

项目	hypo-PTH		非hypo-PTH		$P$ 值
项目	CONUT>4分 ( $n$ =42)	CONUT≤4分 ( $n$ =25)	CONUT>4分 ( $n$ =59)	CONUT≤4分 ( $n$ =67)	$P$ 值
男性[例(%)]	27(64.3)	11(44.0)	34(57.6)	45(67.2)	0.208
年龄(岁)	54.48±17.77	50.92±20.11	55.86±14.52	46.00±15.63^*#	0.005
BMI(kg/m²)	22.94±4.49	23.85±3.73	24.81±4.47	24.14±4.12	0.189
原发病[例(%)]
慢性肾小球肾炎	3(7.1)	6(24.0)	18(30.5)^*	27(40.3)^*	0.002
糖尿病肾病	14(33.3)	5(20.0)	24(40.7)	9(13.4)^#	0.004
高血压肾病	4(9.5)	6(24.0)	7(11.9)	12(17.9)	0.333
狼疮性肾炎	9(21.4)	4(16.0)	3(5.1)^*	3(4.5)^*	0.011
其他病因	12(28.6)	4(16.0)	7(11.9)	16(23.9)	0.157
合并症[例(%)]
心力衰竭					0.035
NYHA心功能
Ⅰ-Ⅱ级	7(16.7)	3(12.0)	15(25.4)	6(9.0)
Ⅲ-Ⅳ级	13(30.9)	7(28.0)	17(28.8)	11(16.4)
无心力衰竭	22(52.4)	15(60.0)	27(45.8)	50(74.6)^#
除腹膜炎外其他部位的感染	12(28.6)	6(24.0)	11(18.6)	7(11.1)	0.089
乙肝或肝硬化	2(4.8)	1(4.0)	9(15.3)	11(16.4)	0.149
激素或免疫抑制剂使用[例(%)]	16(38.1)	5(20.0)	4(6.8)^*	6(9.0)^*	<0.01

Tab.2 Comparison of laboratory data between groups

项目	Hypo-PTH		非Hypo-PTH		$P$ 值
项目	CONUT>4分( $n$ =42)	CONUT≤4分( $n$ =25)	CONUT>4分( $n$ =59)	CONUT≤4分( $n$ =67)	$P$ 值
iPTH( pg/ml)	78.51±41.13	73.07±43.65	347.35±212.02^*&	366.26±195.36^*&	<0.01
CONUT	7(5,8)	3(1, 4)^*#	6(5, 7)	3(2, 4)^*#	<0.01
白细胞计数(×10⁹/L)	7.47±4.76	6.83±2.08	6.25±2.54	6.56±2.16	0.236
血红蛋白(g/L)	90.29±18.16	87.28±12.55	78.76±12.29^*&	86.70±13.96^#	0.001
血小板计数(×10⁹/L)	168.10±77.36	180.28±65.03	142.98±65.39	165.79±58.60	0.064
血钠(mmol/L)	138.96±4.79^&	136.72±3.49	139.03±3.60^&	139.38±3.70^&	0.035
血钾(mmol/L)	4.30±0.75	4.29±0.75	4.33±0.62	4.57±0.75	0.131
尿素氮(mmol/L)	22.82±10.71^&	44.16±30.74	31.72±11.49	34.98±12.35^*	0.037
肌酐(μmol/L)	507.16±249.27	843.37±542.23^*	796.04±319.46^*	976.65±376.67^*#	<0.01
尿酸(μmol/L)	376.66±167.09	443.39±150.23	396.20±133.96	472.27±165.67^*#	0.006
血钙(mmol/L)	1.96±0.24	2.08±0.19	1.82±0.22	1.91±0.21^&#	<0.01
血磷(mmol/L)	1.60±0.58	1.76±0.67	1.93±0.56	2.17±0.56^*&#	<0.01
白蛋白(g/L)	26.81±5.76	35.40±3.97	29.53±3.65	37.04±3.99^*#	<0.01
球蛋白(g/L)	23.96±9.42	26.48±5.55	24.24±8.80	18.50±19.29^*&#	0.022
CRP(mg/L)	4.69(1.09, 20.73)	5.50(0.63, 12.00)	6.37(1.64, 29.68)	1.36(0.50, 6.17)^#	0.004
总胆固醇(mmol/L)	5.14±2.67	5.17±1.51	4.46±1.37	4.57±1.04	0.106
BNP( pg/ml)	337.05(143.23,1428.35)	204.90(104.35,1246.35)	793.70(286.30,1261.00)	220.25(98.13, 577.38)^#	0.004

Tab.2 Comparison of laboratory data between groups

项目	Hypo-PTH		非Hypo-PTH		$P$ 值
项目	CONUT>4分( $n$ =42)	CONUT≤4分( $n$ =25)	CONUT>4分( $n$ =59)	CONUT≤4分( $n$ =67)	$P$ 值
iPTH( pg/ml)	78.51±41.13	73.07±43.65	347.35±212.02^*&	366.26±195.36^*&	<0.01
CONUT	7(5,8)	3(1, 4)^*#	6(5, 7)	3(2, 4)^*#	<0.01
白细胞计数(×10⁹/L)	7.47±4.76	6.83±2.08	6.25±2.54	6.56±2.16	0.236
血红蛋白(g/L)	90.29±18.16	87.28±12.55	78.76±12.29^*&	86.70±13.96^#	0.001
血小板计数(×10⁹/L)	168.10±77.36	180.28±65.03	142.98±65.39	165.79±58.60	0.064
血钠(mmol/L)	138.96±4.79^&	136.72±3.49	139.03±3.60^&	139.38±3.70^&	0.035
血钾(mmol/L)	4.30±0.75	4.29±0.75	4.33±0.62	4.57±0.75	0.131
尿素氮(mmol/L)	22.82±10.71^&	44.16±30.74	31.72±11.49	34.98±12.35^*	0.037
肌酐(μmol/L)	507.16±249.27	843.37±542.23^*	796.04±319.46^*	976.65±376.67^*#	<0.01
尿酸(μmol/L)	376.66±167.09	443.39±150.23	396.20±133.96	472.27±165.67^*#	0.006
血钙(mmol/L)	1.96±0.24	2.08±0.19	1.82±0.22	1.91±0.21^&#	<0.01
血磷(mmol/L)	1.60±0.58	1.76±0.67	1.93±0.56	2.17±0.56^*&#	<0.01
白蛋白(g/L)	26.81±5.76	35.40±3.97	29.53±3.65	37.04±3.99^*#	<0.01
球蛋白(g/L)	23.96±9.42	26.48±5.55	24.24±8.80	18.50±19.29^*&#	0.022
CRP(mg/L)	4.69(1.09, 20.73)	5.50(0.63, 12.00)	6.37(1.64, 29.68)	1.36(0.50, 6.17)^#	0.004
总胆固醇(mmol/L)	5.14±2.67	5.17±1.51	4.46±1.37	4.57±1.04	0.106
BNP( pg/ml)	337.05(143.23,1428.35)	204.90(104.35,1246.35)	793.70(286.30,1261.00)	220.25(98.13, 577.38)^#	0.004

Tab.3 Comparison of the incidence of peritonitis within 30 days after operation between groups

组别	例数	腹膜炎发生率[例(%)]
iPTH≥150 pg/ml,CONUT≤4	67	8(11.94)
iPTH<150 pg/ml,CONUT>4	42	11(26.19)
iPTH<150 pg/ml,CONUT≤4	25	5(20.00)
iPTH≥150 pg/ml,CONUT>4	59	10(16.95)
χ²值
$P$ 值

Tab.3 Comparison of the incidence of peritonitis within 30 days after operation between groups

组别	例数	腹膜炎发生率[例(%)]
iPTH≥150 pg/ml,CONUT≤4	67	8(11.94)
iPTH<150 pg/ml,CONUT>4	42	11(26.19)
iPTH<150 pg/ml,CONUT≤4	25	5(20.00)
iPTH≥150 pg/ml,CONUT>4	59	10(16.95)
χ²值
$P$ 值

Fig.1 Kaplan-Meier survival curves for peritoneal dialysis patients

Fig.2 Forest plot of the cox multivariate regresion analysis a.the cox multivariate regression analysis of PTH and CONUT score for peritoneal dialysis-related peritonitis; b. the cox multivariate regression analysis of PTH and CONUT on poor prognosis in peritoneal dialysis patients

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