The Factors Affecting The Levels Of Blood Ammonia In Continuous Ambulatory Peritoneal Dialysis Patients

Objective:Found that some clinical continuous ambulatory peritoneal dialysis (CAPD) patients with elevated blood ammonia, through the collection of CAPD patients and analyze clinical data to investigate the reasons leading elevated in patients with ammonia, to provide for the prevention of patients with elevated blood ammonia theoretical basis. CAPD patients in this study confirmed the same whether it is associated with liver disease leading cause of elevated blood ammonia were carried out in-depth discussion.Methods: A cross-sectional study was performed in CAPD patients treated in the division of nephrology, Peking University Third Hospital in March 2010.We collected data including venous ammonia, OH, residual renal function, dialysis adequacy and other biochemical indicators. Comparisons between groups and multivariate analysis were used to explore the relationship between the liver diseases and elevated blood ammonia.Results:1,There were 144 cases with peritoneal dialysis patients elected to the present study, there were 26 cases suffering from liver disease, the suffering from liver disease occurred in peritoneal dialysis patients was 18.1%. In this study, in which elevated blood ammonia group of 33 patients with peritoneal dialysis patients, the incidence of elevated blood ammonia was 22.9%;2,Patients were divided into two groups according to have or no liver disease. blood ammonia, gender, ALb, and residual renal function were significantly different in the two groups;3,To explore whether the liver disease associated with blood ammonia levels correlated single factor correlation analysis, the results show: ammonia and age, serum albumin, the square root rKtV and urine were negative, but with sex (male=1, female=0), PNA, blood urea, lgCRP and associated with liver disease (have liver disease=1, normal liver=0),negatively correlated; These results were statistically significant (P<0.05);4,Multivariate analysis further showed that PNA, ALb, residual renal function, and liver diseases were independent risk factors affecting the level of venous ammonia, after adjusting for gender, age, OH, BUN, tKt/V, lgCRP and urine (R2=0.339,P<0.05).Conclusion:1,CAPD patients with end-stage kidney disease with liver disease while at the same time, the patient is indeed more likely to increase blood ammonia levels. Prompt clinicians to pay attention to CAPD patients with end-stage renal disease accompanied by aggressive treatment of liver disease and increase awareness on the protection of the liver;2,Further analysis also suffers from liver disease in CAPD patients with end-stage kidney disease, we found that this part of the relatively poor nutritional status of populations, and residual renal function is relatively poor, consider when CAPD patients with end-stage renal disease accompanied by liver disease may but more likely because of poor clinical condition caused by a further decline in residual renal function, resulting in further increase in blood ammonia;3,From the findings of the research lead to end-stage kidney patients with CAPD are many reasons for elevated blood ammonia combination of factors, so need to further explore study.Objective:To further investigate the cause continuous ambulatory peritoneal dialysis (CAPD) patients with other causes of elevated blood ammonia, liver function abnormalities and the exclusion of the effect of liver disease, and explore the rest of the clinical indicators of blood ammonia levels.Methods: A cross-sectional study was performed in CAPD patients treated in the division of nephrology, Peking University Third Hospital in April 2010. Data on demographic characteristics, blood biochemistries, and dialysis adequacy were collected, hydration status (expressed as OH) was assessed by bioelectrical impedance method, blood ammonia concentration was quantified according to the optical reflection density by FUJI DRI-CHEM analyzer. Hyperammonemia was defined as the level of venous ammonia no less than 48μmol/L.Results:1,There were 144 cases with peritoneal dialysis patients elected to the present study. In which patients with elevated blood ammonia were 31 cases, while patients with normal blood ammonia was 121 cases, the blood ammonia increased the incidence of peritoneal dialysis patients was 20.4%;2,Increased blood ammonia and ammonia under normal peritoneal dialysis patients were divided into two groups, the results of the two groups to have significantly higher plasma ammonia in urine than normal blood ammonia (urine is 32.3% VS 57.0%, P <0.05) the same time, increased blood ammonia OH group was significantly higher than normal blood ammonia, and ammonia increased group tKt/ V and the square root rKt/ V (rKt/ V: 1.61±0.34 VS 1.82±0.37, P <0.01; square root rKt/ V: 0.22±0.34 VS 0.22±0.34, P <0.01) was significantly lower than normal blood ammonia;3,To explore the cause of peritoneal dialysis patients with elevated blood ammonia reasons, a single factor correlation analysis showed that blood ammonia and age, tKt/ V, square root rKt/ V and a urine (urine is 1, no urine is 0) was negatively correlated However, gender (male 1, female 0), OH and the PNA was positively correlated; these results were statistically significant (P<0.05);4,Multiple linear stepwise regression analysis showed that OH, PNA, and the square root rKt/V were independent risk factors affecting the levels of blood ammonia, after adjusting for gender, age, tKt/V, and the urine (R2 = 0.229, p <0.05).Conclusion:1,Ruled out liver function on blood ammonia levels and found that residual renal function decline and more of the protein diet of CAPD patients remained independent factors of blood ammonia levels; the volume overload had become another cause elevated blood ammonia an independent risk factors;2,Therefore, this study suggests that peritoneal dialysis patients to strictly control the sodium, water and protein intake, to actively protect the residual renal function in patients, when patients had no residual renal function to ensure adequate dialysis patients, so as to ensure the maintenance of blood ammonia in patients with CAPD In the normal level, which control the occurrence of hyperammonemia.