无尿长程腹膜透析患者全因死亡与技术失败风险因素分析  

All-cause mortality and technical failure risk in long-term maintenance peritoneal dialysis patients with anuria

作　　者：张志宏 于文馨 周婷婷 成水芹 俞雨生 ZHANG Zhihong*;YU Wenxin*;ZHOU Tingting;CHENG Shuiqin;YU Yusheng(National Clinical Research Center for Kidney Diseases,Jinling Hospital,Nanjing 210016,China)

机构地区：[1]东部战区总医院、国家肾脏疾病临床医学研究中心,南京210016

出　　处：《肾脏病与透析肾移植杂志》2024年第6期521-527,共7页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：江苏省肾脏病医学创新中心项目(CXZX202202);东部战区总医院临床诊疗新技术项目(22LCZLXJS25)。

摘　　要：目的:无尿长程腹膜透析(PD)患者随访困难,全因死亡与技术失败风险高。本研究利用门诊随访资料对该类人群上述风险进行分析。方法:单中心回顾性研究,纳入国家肾脏疾病临床医学研究中心规律随访透析龄≥5年且尿量≤100 mL/24h持续≥3月的PD患者。以2019年门诊随访记录作为基线,采集一般资料、实验室检验等信息。研究对象持续随访至2024年7月,定义观察终点为:(1)全因死亡;(2)技术失败。其中技术失败定义为转血液透析持续3月及以上。以是否发生全因死亡或技术失败分组,比较两组患者基线参数差异,结合受试者操作曲线(ROC)和多因素COX回归分析基线参数的预测价值。结果:共纳入255例患者,平均年龄53.0±12.6岁,其中男性104例(40.7%),纳入研究时中位透析龄为79月,总尿素清除指数(Kt/V) 1.76±0.42,腹膜高转运/高平均转运73例(28.6%)。至随访期末,发生死亡29例,技术失败92例。以是否发生全因死亡或技术失败分组,两组患者的年龄、体质量指数、血清尿酸、血清白蛋白、血钠、血清肌酐(SCr)与胱抑素C(CysC)浓度比值(Cr/CysC)、总尿素清除指数(Kt/V)和腹膜转运类型的差异均有统计学意义(均P<0.05);ROC曲线下面积最大变量为Cr/CysC,其次为总Kt/V。所有患者Cr/CysC平均水平为1.91±0.56。多因素COX回归分析提示,全因死亡或技术失败复合终点的独立影响因素为年龄、性别、总Kt/V、腹膜转运类型和Cr/CysC,而全因死亡的独立影响因素为年龄、性别、总Kt/V和Cr/CysC。以总Kt/V 1.70与Cr/CysC 1.90(最接近Cr/CysC 1.91数值)对患者进行三分组,患者生存曲线与技术生存曲线均提示,基线总Kt/V<1.70且Cr/CysC<1.90的患者预后不佳(P均<0.01)。结论:基线Cr/CysC水平是无尿长程PD患者全因死亡与技术失败的独立影响因素,Cr/CysC联合总Kt/V有助于该类患者预后判断。Objective:Follow-up of patients with anuria on long-term maintenance peritoneal dialysis(PD)presents significant challenges,and the risks of all-cause mortality and technical failure are high.This study uses baseline information from outpatient follow-up data to predict and analyze the above risks for this group of people.Methodology:This single-center retrospective study included PD patients who were regularly followed up on dialysis for≥5 years and whose urine volume≤100 ml/24h for 3 at least months.Using the outpatient follow-up records in 2019 as the baseline,information including demographic information,laboratory tests and other information were collected.The study subjects will continue to be followed up until July 2024,and the observation endpoints are defined as all-cause mortality,and technical failure.Technical failure was defined as conversion to hemodialysis lasting 3 months or more.The patients were divided into groups based on whether death or technical failure occurred,and the differences in baseline parameters between the two groups were compared.The predictive value of the baseline parameters was analyzed using receiver operating curve(ROC)and multivariate COX regression.Results:A total of 255 patients were included,with an average age of 53.0±12.6 years,of whom 104(40.7%)were male.The median(quartile)dialysis months at the time of inclusion in the study was 79(65-105)months,and the total urea clearance index(Kt/V)1.76±0.42,high peritoneal transport/high average transport in 73 cases(28.6%).By the end of the follow-up period,a total of 121 end-point events were recorded,including 29 deaths and 92 technical failures.Grouped according to whether death or technical failure occurred,there were statistically significant differences in the age,body mass index,serum uric acid,serum albumin,serum sodium,serum creatinine(Scr)and cystatin C(CysC)concentration ratio(Cr/CysC),total Kt/V and peritoneal transport types,(all P<0.05).Evaluated by the occurrence of all-cause mortality or technical failure,

关 键 词：腹膜透析 尿素清除指数 血清肌酐/胱抑素C比值 

分 类 号：R692.5[医药卫生—泌尿科学]