腹膜透析患者出现肾功能恢复—单中心队列研究  

Renal recovery in peritoneal dialysis patient–a single center cohort study

作　　者：黄佳颖[1] 贺燕娜 方炜[1] 金海姣 倪兆慧[1] 俞赞喆[1] HUANG Jia-ying;HE Yanna;FANG Wei;JIN Hai-jiao;NI Zhao-hui;YU Zan-zhe(Department of Nephrology,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院肾脏科,上海200127

出　　处：《中国血液净化》2021年第11期728-731,736,共5页Chinese Journal of Blood Purification

基　　金：上海市卫生健康委员会卫生公益行业专项青年项目(20194Y0332);中华医学会临床医学科研专项资金(20010010793);扬帆计划(21YF1425400)。

摘　　要：目的腹膜透析通常用于终末期肾病患者的长期肾脏替代治疗。自各国透析登记系统的资料均显示开始维持性透析的患者有一定比例会出现肾功能恢复并脱离透析,然而这部分患者的特征并不清楚。本研究旨在描述这部分患者的特征。方法本研究为单中心队列研究。在上海交通大学医学院附属仁济医院置管并规律随访的腹膜透析患者,筛选出行长期肾脏替代治疗开始腹膜透析治疗后因肾功能恢复退出腹膜透析的患者,对其开始透析时的诊断,人口学和生物学指标进行回顾性分析。结果1986年6月~2018年1月,在上海交通大学医学院附属仁济医院置管并规律随访的腹膜透析患者1623例。其中符合入、排标准患者10例[女/男,4/6,年龄(56±22)岁]。8例为首次就诊肾脏科即收治入院并开始腹膜透析治疗的患者。肾功能恢复时长60~634天、中位时间343(142,467)天。这组患者在开始透析时多数存在贫血,低钙,高磷情况,部分存在尿量减少,但肾脏缩小不明显。结论少数开始透析时诊断为终末期肾病的患者,在替代治疗相当一段时间后仍可能出现肾功能恢复。在既往病史不详的患者中发生率较高。在这部分患者中,如肾脏缩小不明显,应尤为注意,加强残余肾功能保护,避免肾损害因素。Objective Peritoneal dialysis(PD)is mostly used as a long term renal replacement therapy for end stage renal disease(ESRD).Data from the dialysis registration systems of various countries shown that a certain number of patients experience renal recovery after on peritoneal dialysis for a while.However,the characteristics of these patients are far from clear.This paper is to explore the characteristics of these patients.Methods This is a single center cohort study.The long term PD patients in our center were followed up until death or withdraw PD.We analyzed the characteristics of the patients who start PD for ESRD and withdraw PD for renal function recovery.Results There were 1623 patients started PD between June,1986 to January,2018 in our PD center.10 patients(including 6 males;mean age:56±22)were included in the analysis.8 of the 10 patients started PD after their first presenting in nephrology clinic.The time phase from renal replacement therapy until renal recovery was between 60 to 634 days(medium(quartiles):343(142,467)days).Most of these patients had anemia,hypocalcemia,and hyperphosphatemia when they started PD,and some had decreased urine output,but the kidney size was generally preserved in most cases.Conclusions A few patients diagnosed with ESRD at the beginning of dialysis may still have renal function recovery after a considerable period of replacement therapy,especially in those without clear past disease history and with preserved kidney size.It is important recognize these patients and protect residual renal function and avoid renal damage factors.

关 键 词：尿毒症 腹膜透析 队列研究 急性肾损伤 

分 类 号：R459.5[医药卫生—治疗学]