不同透析时机对腹膜透析患者预后影响的回顾性队列研究  

Effects of timing of dialysis initiation on the prognosis of peritoneal dialysis patients:a retrospective cohort study

作　　者：刘小燕 黄晓彦[1] 梁伟[1] 何艳[1] 熊祖应[1] 熊子波[1] Liu Xiaoyan;Huang Xiaoyan;Liang Wei;He Yan;Xiong Zuying;Xiong Zibo(Department of Nephrology,Peking University Shenzhen Hospital,Shenzhen 518000,China;Department of Nephrology,Shenzhen Luohu District Hospital of Traditional Chinese Medicine,Shenzhen 518000,China)

机构地区：[1]北京大学深圳医院肾内科,深圳518000 [2]深圳市罗湖区中医院肾病科,深圳518000

出　　处：《中华肾脏病杂志》2020年第12期936-941,共6页Chinese Journal of Nephrology

基　　金：深圳市三名工程项目资助(SZSM201812097)。

摘　　要：目的探讨不同透析时机对腹膜透析(腹透)患者预后的影响。方法回顾性分析2012年1月1日至2019年3月25日在北京大学深圳医院接受腹透新置管并长期随访患者的临床资料。根据患者接受置管术时的估算肾小球滤过率(eGFR)将入选患者分为早透析组[eGFR>5.5 ml·min^-1·(1.73 m^2)^-1]和晚透析组[eGFR≤5.5 ml·min^-1·(1.73 m^2)^-1],随访终点事件为转其他肾脏替代治疗(如血液透析、肾移植)或死亡。采用Kaplan-Meier法绘制生存曲线,Log-rank检验比较两组患者间生存率的差异。用Cox比例风险模型法分析腹透患者全因死亡及技术死亡的影响因素。结果共342例腹透患者入选本研究,早透析组165例,晚透析组177例。与早透析组比较,晚透析组患者合并糖尿病比例、男性比例及血红蛋白、血钙及CO2结合力水平较低,而合并高血压比例、血磷、血尿酸、血尿素氮水平较高(均P<0.05)。中位随访时间33(16,57)个月。Kaplan-Meier生存分析结果显示,晚透析组患者累积生存率显著高于早透析组(Log-rankχ^2=12.004,P<0.001)。在校正性别、置管年龄、体重指数、合并糖尿病及高血压等因素后,早透组患者发生全因死亡事件的风险比是晚透组的1.950倍[HR=1.950,95%CI 1.019~3.730,P=0.044]。亚组分析结果显示,透析时机与终点事件发生风险不受体重指数、糖尿病分层等因素影响(交互P值均>0.05),但与置管年龄存在交互(交互P值<0.05)。按置管年龄进行分层后分析结果显示,低年龄(≤48岁)早透析组患者的全因死亡风险更高(HR=21.287,95%CI 2.609~173.665,P=0.004)。结论早透析组腹透患者的病死率更高,该差异在低年龄组更明显,且独立于性别、年龄、体重指数、糖尿病及高血压。Objective To analyze the effects of dialysis therapy initiation on the prognosis of peritoneal dialysis(PD)patients.Methods PD patients who were newly catheterization and long-term followed-up in Peking University Shenzhen Hospital from January 1,2012 to March 25,2019 were retrospectively analyzed.According to the estimate glomerular filtration rate(eGFR)at the time of patients catheterization,the patients were divided into early-dialysis group[eGFR>5.5 ml·min^-1·(1.73 m^2)^-1]and late-dialysis group[eGFR≤5.5 ml·min^-1·(1.73 m^2)^-1].The endpoint events were transferred to other renal replacement therapy(such as hemodialysis,kidney transplantation)or death.Kaplan-Meier method was used to draw survival curve,and log-rank test was used to compare the difference of survival rate between the two groups.Cox proportional hazard model was used to analyze the influencing factors of all-cause death and technical death in PD patients.Results A total of 342 PD patients were enrolled in this study,and there were 165 cases and 177 cases in the early-dialysis and the late-dialysis group respectively.Compared with the early-dialysis group,the proportion of patients with diabetes and men,and the level of hemoglobin,serum calcium and CO2 binding capacity in the late-dialysis group were lower,while the incidence of hypertension,serum phosphorus,blood uric acid and blood urea nitrogen level were higher in the late-dialysis group(all P<0.05).The median follow-up time was 33(16,57)months.Kaplan-Meier survival analysis showed that the cumulative survival rate of late-dialysis group was significantly higher than that of early-dialysis group(Log-rankχ^2=12.004,P<0.001).After adjusting for gender,age of catheterization,body mass index(BMI),diabetes mellitus and hypertension,the risk ratio of all-cause death in the early-dialysis group was 1.950 times higher than that in the late-dialysis group(HR=1.950,95%CI 1.019-3.730,P=0.044).Subgroup analysis showed that the timing of dialysis and the risk of end-point events were not affected

关 键 词：腹膜透析 预后 队列研究 回顾性研究 

分 类 号：R692.5[医药卫生—泌尿科学]