尿量下降速率与腹膜透析患者不良预后的相关性分析  

The association between urine volume decline rate and prognosis of peritoneal dialysis patients

作　　者：赖美霞 吴婷婷[1] 张骥[1] LAI Meixia;WU Tingting;ZHANG Ji(Department of Nephrology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院肾内科,温州325000

出　　处：《肾脏病与透析肾移植杂志》2024年第6期528-534,共7页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:探讨腹膜透析(PD)患者尿量下降速率与不良预后之间的关系。方法:纳入1996年3月至2022年12月在温州医科大学附属第一医院肾内科规律随访的PD患者。收集这些患者的一般资料和实验室指标,计算尿量下降速率,并进一步分析尿量下降速率与不良预后[全因死亡和永久转为血液透析(HD)]的相关性。结果:共纳入1 090例PD患者,男性622例、女性468例。开始PD的平均年龄49.12±13.33岁,尿量960.28±436.80 mL/24h。中位随访时间55.05±40.04月。不良预后发生317例(29.9%),其中死亡115例(10.6%)和永久性转为HD 202例(18.5%)。根据尿量下降速率(斜率的绝对值)的对数值按四分位数分组,分别为快下降组[Q1组:(2.80, 4.48)]、快平均下降组[Q2组:(2.08, 2.80)]、慢平均下降组[Q3组:(1.42, 2.08)]和慢下降组[Q4组:(0.05, 1.42)]。四组患者在性别、年龄、不良预后发生率、随访时间、残余尿量、血清白蛋白、血红蛋白、尿素氮及甲状旁腺激素等方面的差异均具有统计学意义(P<0.05)。Kaplan-Meier生存分析显示,尿量下降速率与不良预后显著相关(log-rank检验,P<0.001)。多因素COX回归显示,矫正年龄、收缩压、血清白蛋白、总胆固醇等混淆因素后,尿量下降速率是PD患者不良预后的独立危险因素。尿量下降速率每增加1个单位,发生不良预后的风险增加3.77倍(模型2:P<0.001)。结论:尿量下降速率是PD患者不良预后的独立危险因素。加强人群个体化管理,保护患者残余尿量有助于改善PD患者的预后。Objective:To investigate the relationship between the rate of urine volume decline and adverse outcomes in peritoneal dialysis(PD)patients.Methodology:This study enrolled PD patients who received regular follow-ups at the Peritoneal Dialysis Center,Department of Nephrology,First Affiliated Hospital of Wenzhou Medical University,between March 1996 and December 2022.Demographic data and laboratory parameters were collected,and the rate of urine output decline was calculated.The association between the rate of urine output volume and adverse outcomes(all-cause mortality and permanent transition to hemodialysis)was further analyzed.Results:A total of 1,090 PD patients were included,of whom 622(57.1%)were male.The mean age at the initiation of PD was 49.12±13.33 years,with a baseline urine volume of 960.28±436.80 mL.The median follow-up duration was 55.05±40.04 months.Adverse outcomes occurred in 317 patients(29.9%),including 115 deaths(10.6%)and 202 permanent transitions to hemodialysis(18.5%).Based on the logarithmic values of urine volume decline rates(absolute slope values),patients were divided into four groups:rapid decline group[Q1:(2.80,4.48)],moderate-rapid decline group[Q2:(2.08,2.80)],moderate-slow decline group[Q3:(1.42,2.08)],and slow decline group[Q4:(0.05,1.42)].Significant differences were observed among the four groups in terms of gender,age,adverse outcome rates,follow-up duration,residual urine volume,serum albumin,hemoglobin,blood urea nitrogen,and parathyroid hormone levels(P<0.05).Kaplan-Meier survival analysis revealed a significant association between the rate of urine volume decline and adverse outcomes(log-rank test,P<0.001).Multivariate Cox regression analysis,after adjusting for confounding factors such as age,systolic blood pressure,serum albumin,and total cholesterol,identified the rate of urine volume decline as an independent risk factor for adverse outcomes in PD patients.For every unit increase in the rate of urine volume decline,the risk of adverse outcomes increased by 3.77 times

关 键 词：腹膜透析 尿量 残余肾功能 不良预后 

分 类 号：R692.5[医药卫生—泌尿科学]