老年血液透析和腹膜透析患者生存分析的单中心回顾性研究  

Comparison of Survival Between Hemodialysis and Peritoneal Dialysis Among Elderly End-stage Renal Disease Patients in a Single Center

作　　者：刘书馨[1] 王丹 刘红[1] 滕兰波[1] 赵华[1] 常明[1] 

机构地区：[1]辽宁省大连市中心医院肾内科,大连116033 [2]辽宁省大连市第五人民医院肾内科,大连116000

出　　处：《中国中西医结合肾病杂志》2016年第9期781-784,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：辽宁省自然科学基金资助项目(No.2013020224);大连市科技局计划项目(No.2014E14SF151)

摘　　要：目的：探讨老年终末期肾脏病患者行血液透析（HD）或腹膜透析（PD）治疗的生存差异。方法：选择2010年1月1日-2014年12月31日于我院肾内科首次开始HD或PD治疗并于我科长期进行随访治疗的年龄≥65岁老年终末期肾脏病（ESRD）患者。HD组采用双重反渗水和标准碳酸氢盐透析治疗,3次/周,每次4 h。PD组采用持续不卧床腹膜透析治疗（CAPD）,8-10 L/d。观察终点事件为全因死亡。记录患者性别、开始透析时年龄和原发病,存活时间为开始透析至死亡的时间,删失值定义为至2014年12月31日仍存活或失访患者,时间记录单位为月。生存分析采用Kaplan-Meter分析,生存率比较采用log-rank检验。开始透析年龄、性别、原发病、透析方式对生存的影响采用Cox回归分析。采用SPSS 13.0进行统计学分析,P〈0.05差异有统计学意义。结果：共有185例符合条件患者入组,其中HD组123例,PD组62例。男81例,女104例,平均年龄（73.1±5.6）岁,平均随访时间（23.8±15.1）月。原发病糖尿病肾病78例,慢性肾小球肾炎18例,高血压肾损害78例,其他病因11例。两组患者在男女比例、年龄、原发病分布比较差异无统计学意义（P〉0.05）。HD组中位生存时间为48.0月,1年、2年、3年、4年生存率分别为74%、62%、57%、57%。PD组中位生存时间为29.6月,1年、2年、3年、4年生存率分别为60%、39%、21%、21%。log-rank检验结果显示两组患者生存率比较差异有统计学意义（χ^2=7.423,P=0.006）,HD组显著高于PD组。采用Cox回归分析进行生存分析,使用性别、开始透析时年龄、原发病、透析治疗方式（HD或PD）进行校正,发现女性、开始透析时年龄、PD治疗是死亡的独立预测因子（P〈0.05）,原发病对死亡无显著影响。结论：在本中心,经年龄、性别、原发病校正后,年龄≥65岁老年ESRD患者HD治疗的生存率显著高于PD治疗的生存率。Objective ：To explore the survival difference between hemodialysis （HD） and peritoneal dialysis （PD） modality in elderly endstage renal disease patients. Methods：Elderly （age≥65） endstage renal disease patients who had initially started HD or PD treatment and long -term followed in our department from 1 Jan 2010 to 31 Dec 2014 were enrolled. HD treatment was giv- en three times per week and CAPD dosage was 8 - 10 L/d. The end point was time to death. The sex, age, primary renal disease were documented. Survival between the dialysis modalities was compared by Kaplan - Meier plots and log - rank test. Survival was timed from the start of dialysis until the date of death and was censored for the date of end of the study period （31 December 2014）. Multivariate analysis was by Cox regression model with survival of patients on dialysis modalities adjusted for sex, age at onset of RRT, primary renal disease. SPSS for Windows version 13.0 was used for the analysis. Results：A total of 185 elderly dialysis pa- tients were enrolled among whom 123 patients accepted HD and others accepted PD. The average age at onset of RRT was （73.1 ± 5.6）. There were 78 cases of diabetic nephropathy, 18 cases of chronic glomerulonephritis, 78 cases of hypertensive and 11 cases of other cause of kidney injury. There were no significant differences in sex, age and primary renal disease between two groups. The median survival time of HD patients was 48.0 months and the 1 - , 2 - , 3 - , 4 - year survival rate was 74% , 62% , 57% , 57% re- spectively. The median survival time of PD patients was 29.6 months and the 1 - , 2 - , 3 - , 4 - year survival rate was 60%, 39% , 21%, 21% respectively. Log- rank test suggested that the mortality in PD patients was significantly higher than in HD patients （X2 = 7. 423, P = 0. 006）. After adjusted by sex, age at onset of RRT, primary renal disease and dialysis modality, Cox regression model showed that female, age at onset of RRT and PD were independent predictors for death.

关 键 词：老年患者 血液透析 腹膜透析 生存 

分 类 号：R459.5[医药卫生—治疗学]