中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (10): 676-680.doi: 10.3969/j.issn.1671-4091.2017.010.009

• 临床研究 • 上一篇    下一篇

终末期肾脏病腹膜透析患者长期预后及其透析前危险因素的研究

姜俊1,兰雷1,周晓婉1,彭丽1,任伟1   

  1. 1. 安徽医科大学附属省立医院南区肾脏科
  • 收稿日期:2017-05-04 修回日期:2017-08-13 出版日期:2017-10-12 发布日期:2017-10-12
  • 通讯作者: 任伟 renweisn@163.com E-mail:renweisn@163.com

Long-term outcome and risk factors in patients with end stage renal disease on peritoneal dialysis

  • Received:2017-05-04 Revised:2017-08-13 Online:2017-10-12 Published:2017-10-12

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摘要： 目的探讨终末期肾脏病腹膜透析(peritoneal dialysis, PD)患者的长期预后，并进一步研究了影响终末期肾脏病PD 患者长期预后的透析前危险因素。方法选取安徽省立医院2011 年1 月至2013 年12 月期间以PD 作为初始肾替代治疗的终末期肾病患者，随访3 年，记录3 年内患者的生存、转血液透析或死亡等结局,采用Kaplan-Meier 方法计算患者累积存活率及技术存活率，采用Cox 回归模型分析PD 患者生存及技术存活的透析前危险因素，并计算各个危险因素的相对危险度(relative risk, RR)及95%可信区间(confidence interval,CI)。结果100 例终末期肾脏病PD 患者1 年、2 年、3 年累积生存率分别为95.8%、87.4%、76.7%，Cox 单因素回归分析显示腹膜透析开始时年龄(RR 1.042，95% CI1.012～1.073，P=0.006)、低血清白蛋白(RR 0.872，95% CI 0.800～0.950，P=0.002)及慢性心功能不全(RR 3.545，95% CI 1.336～9.409，P=0.011)可能是影响PD 患者生存预后的危险因素。PD 患者1 年、2年、3 年累积技术存活率分别为90.8%、82.5%、65.5%，Cox 回归分析显示透析开始时低血清白蛋白(RR0.932，95% CI 0.870～0.998，P=0.042)是PD 患者掉队的危险因素。结论本中心PD 患者有较好的生存率和技术存活率，影响PD 患者生存率的透析前因素可能有年龄、低血清白蛋白血症及慢性心功能不全，而影响PD 患者技术存活率的透析前因素主要为低血清白蛋白血症。透析前低血清白蛋白血症的PD患者的长期预后不佳，重视透析前低白蛋白血症的防治可能会改善患者的长期预后。

关键词: 终末期肾病, 腹膜透析, 长期预后, 危险因素

Abstract: Objective To investigate long- term outcome and the risk factors influencing the long- term prognosis in patients with end stage renal disease (ESRD) on peritoneal dialysis (PD). Methods The ESRD patients treated with PD as the initial renal replacement therapy in Anhui Provincial Hospital from Jan. 2011 to Dec. 2013 were enrolled in this study. They were followed up for 3 years and their outcomes were recorded. Kaplan-Meier survival curve was used to calculate cumulative survival rate and technique survival rate. Cox regression models were used to analyze the risk factors for mortality and PD technical failure, and to calculate their relative risk (RR) and 95% confidence interval (CI). Results A total of 100 patients were recruited. The cumulative survival rates after 1, 2 and 3 years were 95.8%, 87.4% and 76.7%, respectively. Cox regression showed that age (RR 1.042, 95% CI 1.012～1.073, P=0.006), lower serum albumin (RR 0.872, 95% CI 0.800～0.950, P=0.002) and chronic heart failure (RR 3.545, 95% CI 1.336～9.409, P=0.011) at the beginning of PD were the risk factors for survival in PD patients. The cumulative technical survival rates after 1, 2 and 3 years were 90.8%, 82.5% and 65.5%, respectively. Cox regression revealed that lower serum albumin level at the beginning of PD (RR 0.932, 95% CI 0.870～0.998, P=0.042) was the risk factor for dropout of the treatment in PD patients. Conclusions The PD patients treated in this department had better survival rate and technical survival rate. The factors at the beginning of PD that affected survival rate included age, lower serum albumin and chronic heart failure, and the factor at the beginning of PD that affected technical survival rate was lower serum albumin. The PD patients with hypoalbuminemia had poor long-term prognosis. Correction of low serum albumin before PD may improve the long-term prognosis.

Key words: End stage renal disease, Peritoneal dialysis, Long-term outcome, Risk factor