中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (03): 170-176.doi: 10.3969/j.issn.1671-4091.2018.03.006

• 临床研究 • 上一篇    下一篇

单中心996 例腹膜透析患者的转归分析

闵永龙1,2,刘红2,李红波2,张燕敏2,毛东东1,2,熊飞2   

  1. 1. 湖北中医药大学
    2. 武汉市第一医院肾内科
  • 收稿日期:2017-10-12 修回日期:2018-01-02 出版日期:2018-03-12 发布日期:2018-03-12
  • 通讯作者: 熊飞 xiongf23@sina.com E-mail:xiongf23@sina.com
  • 基金资助:

    2016 年武汉市卫计委项目武汉地区血液透析规范化研究(WG16D15)

The outcome of 996 peritoneal dialysis patients in a single center

  • Received:2017-10-12 Revised:2018-01-02 Online:2018-03-12 Published:2018-03-12

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摘要： 【摘要】目的分析我院腹膜透析患者的临床资料，探讨其临床特点及临床转归。方法对武汉市第一医院1996 年1 月1 日～2016 年12 月1 日行腹膜透析治疗的996 例患者的临床资料进行回顾整理，分析其人口学资料、居住地、费用类别、文化程度、原发病、转归及转归原因等。结果共996 例腹膜透析患者纳入本研究，其中男性488 例(49.0%)，女性508 例(51.0%)；开始腹膜透析时的平均年龄为(54.93±14.50)岁，平均透析龄为(41.58±33.72)月；原发病中原发性肾小球肾炎占第1 位，为385 例(38.7%)，其次为高血压肾病240 例(24.1%)，糖尿病肾病143 例(14.4%)。至2016 年12 月1 日，继续行腹膜透析的有413 例(41.5%)，死亡319 例(32.0%)，转血液透析178 例(17.9%)，肾移植49 例(4.9%)，失访37 例(3.7%)；总的退出患者的腹透治疗时间(time on therapy ,TOT)为35.96 月，历年TOT 呈上升趋势，2016 年达平均48.89 月；掉队率(drop out rate,DOR)总体呈下降趋势，2016 年仅9.28%。将不同时期退出率及退出原因进行比较得出，C 期(2010-2016 年)退出率较A 期(1996-2002 年)、B 期(2003-2009 年)明显降低(c2 =275.543，P =0.000)，C 期死亡在退出原因中所占的比例较A 期、B 期明显降低(c2 =8.063，P =0.018)，C 期肾移植在退出原因中所占比例较A 期、B 期明显升高(c2 =9.649，P =0.008)，而转血透和失访在不同时期的退出原因中所占比例的差异无统计学意义(c2=3.100, 1.631, P =0.212, 0.442)；对可能影响患者退出和死亡因素进行分析得出，患者性别在退出率和死亡率方面差异无统计学意义(c2=1.774, 0.135, P =0.183，0.713)；长居地在市区、自费、文盲、原发性肾小球肾炎的患者具有更高的退出率(c2=19.690、41.145、8.004、14.553，P =0.000、0.000、0.046、0.001)，而且同时具有更高的死亡率(c2=10.935、16.344、23.854、34.051，P =0.040、0.000、0.000、0.000)。在已知的死亡原因中，心血管事件排首位(19.1%)；其次为感染(11.6%)，包括肺部感染(3.1%)和腹膜炎(8.5%)，及脑血管事件(11.6%)；第3 位死亡原因是营养不良(5.0%)。转血液透析最主要的原因为腹膜炎(51.1%)；然后是导管功能不良(堵管、漂管等，20.2%)；透析不充分(7.9%)。多因素COX 回归模型计算风险比值(hazard ratio，HR)，本中心腹膜透析患者死亡的独立危险因素是老龄(HR:1.052,P =0.000)、低学历(HR:1.420，P =0.004)、原发性肾小球肾炎(HR:0.672，P =0.002)、心血管疾病(HR:2.788，P =0.000)。结论在我中心，腹膜透析患者退出的最主要原因是死亡，其次是转至血液透析。心血管事件是第1 位的死亡原因，腹膜炎是转血液透析的最主要原因。另外，患者学历、费用类别、长居地等因素也会影响患者退出率和死亡率。老龄、低学历、原发性肾小球肾炎、心血管疾病患者有着更高的死亡风险。

关键词: 腹膜透析, 转归, 退出原因, 危险因素

Abstract: 【Abstract】Objective To analyze the clinical features and outcomes of peritoneal dialysis (PD) patients in our hospital. Methods We retrospectively analyzed 996 PD patients treated in our hospital for more than 3 months and followed up for more than 3 months during the period from Jan. 1st, 1996 to Dec. 1st, 2016. Their demographic characteristic, living place, medical insurance type, education level, primary disease, outcome and its related factor were recruited and analyzed. Results A total of 996 patients were enrolled in this study, in which 488 were males (49%) and 508 were females (51%), the mean age at the beginning of PD was 54.93±14.50 years, and the mean peritoneal dialysis duration was 41.58±33.72 months. The primary diseases for end stage renal disease were primary glomerulonephritis (38.7%), hypertension (24.1%) and diabetes (14.4%), in which primary glomerulonephritis was the most important primary disease. Up to Dec. 1st, 2016, the patients remained on PD in 413 cases (41.5%), died in 319 cases (32%), changed to hemodialysis in 178 cases (17.9%), treated with kidney transplant in 49 cases (4.9%), and dropped out of our follow-up in 37 cases (3.7%). In the 583 cases (58.5%) dropped out of PD, time on therapy (TOT) was 35.96 months; TOT increased gradually with year and was 48.89 months in 2016. The dropout rate (DOR) decreased gradually and was only 9.28% in 2016. The DOR was significantly lower in stage C (2010～2016) than in stage A (1996～2002) and stage B (2003～2009) (c2=275.543, P=0.000). Death as the dropout cause turned into less in stage C than in stages A and B (c2=8.063, P=0.018). Kidney transplantation as the dropout cause became more in stage C than in stages A and B (c2=9.649, P=0.008). However, there were no significant differences in the proportion of transfer to hemodialysis and loss of follow-up as the dropout causes between stages A, B and C (c2= 3.100 and 1.631, P=0.212 and 0.442). Gender did not affect the dropout rate and mortality rate (c2=1.774 and 0.135, P=0.183 and 0.713), but living in urban area, less medical insurance, illiteracy and glomerulonephritis as the primary disease were the factors for a higher dropout rate (c2=19.690, 41.145, 8.004 and 14.553 respectively; P=0.000, 0.000, 0.046, and 0.001 respectively) and a higher mortality rate (c2=10.935, 16.344, 23.854 and 34.051 respectively; P=0.040, 0.000, 0.000 and 0.000 respectively). The main cause of death was cardiovascular events (19.1%), followed by cerebrovascular events (11.6%), infection (11.6%) including pulmonary infection (3.1%) and peritonitis (8.5%), and malnutrition (5%). The major reason for transfer to hemodialysis was PD-related peritonitis (51.1%) followed by dysfunction of peritoneal catheter (20.2%) such as occlusion and drift, and insufficient peritoneal dialysis (7.9%). Cox proportional hazards model analyses indicated that the risk factors for mortality were older age (HR: 1.052, P=0.000), lower education level (HR: 1.420, P=0.004), primary glomerulonephritis (HR: 0.672, P=0.002) and cardiovascular diseases (HR: 2.788, P=0.000). Conclusion In this peritoneal dialysis center, the major cause of dropout from PD was death, followed by the transfer to hemodialysis. Cardiovascular event was the most important cause of death, and peritonitis was the major reason for the change from PD to hemodialysis. In addition, factors such as living place, type of medical insurance and education level also affected the dropout rate and mortality in PD patients. Older age, lower education level, primary glomerulonephritis and cardiovascular disease were the risk factors for all causedeath.

Key words: Peritoneal dialysis, Outcome, Dropout cause, Risk factor