中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (03): 160-165.doi: 10.3969/j.issn.1671-4091.2019.03.005

• 临床研究 • 上一篇    下一篇

自动化腹膜透析治疗终末期糖尿病肾病患者长期预后分析

夏鹏1,王海云1,黎颖2,王颖1,田东丽1,周紫娟1,郑华1,李阳1,刘炳岩1,秦岩1,李雪梅1,陈丽萌1   

  1. 1 中国医学科学院北京协和医学院北京协和医院肾内科
    2 重庆市中医院肾病科(夏鹏、王海云为共同第一作者)
  • 收稿日期:2018-10-19 修回日期:2018-11-05 出版日期:2019-03-12 发布日期:2019-03-05
  • 通讯作者: 陈丽萌 chenlpumch@163.com E-mail:chenlpumch@163.com
  • 基金资助:

    国家自然科学基金(81470937,81641024)；中国医学科学院医学与健康科技创新工程经费资助(2016-12M-2-004)；宁夏回族自治区重点研发计划(对外科技合作专项)东西部合作项目(2018YBZD0557)；北京协和医学院教学改革基金(2016zlgc0103)

Long-term prognosis of end stage diabetic kidney disease patients treated with automated peritoneal dialysis

  • Received:2018-10-19 Revised:2018-11-05 Online:2019-03-12 Published:2019-03-05

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摘要： 【摘要】目的观察自动化腹膜透析(automated peritoneal dialysis，APD)和持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis，CAPD)治疗终末期肾病，特别是糖尿病肾病患者的临床特点和预后，分析影响患者长期生存的危险因素。方法采用回顾性队列研究，纳入2002 年9 月1 日～2018 年6 月30 日于北京协和医院开始规律腹膜透析超过3 个月的成年患者，采集患者进入腹膜透析时的基线资料，随访至2018 年9 月30 日。以死亡为观察终点，比较APD 和CAPD 患者、糖尿病肾病(diabetic kidney disease，DKD)和非糖尿病肾病患者的长期生存，并进行单因素和多因素COX 回归分析。结果本研究共纳入534 例腹膜透析患者，和非DKD 组(n=336)相比，DKD 组(n=198)患者年龄更大(t=5.759,P＜0.001)、心血管合并症比例更高(χ2=23.301,P＜0.001)，开始腹膜透析时肌酐值更低[DKD 组比非DKD 组：(620.4±228.9)μmol/L 比(808.0±352.0)μmol/L, t=-6.556, P＜0.001]。长期APD 患者共92 例，1、3、5 和10 年生存率分别为92%，78%，65%和42%，CAPD 患者相应的生存率则为83%，65%，42%和22%，中位生存时间APD 组显著优于CAPD 组(92.3 月比64.3 月，χ2=8.675，P=0.003)，DKD 患者长期预后较非DKD患者差(中位生存时间47.9 月比92.3 月，χ2=46.379, P＜0.001)，其中CAPD 治疗的DKD 患者预后最差(中位生存时间45.2 月，χ2= 55.545, P＜0.001)。多因素COX 分析显示，APD 患者的年龄(β=0.086, HR=1.090, 95% CI：1.039～1.144, P＜0.001)、合并糖尿病(β=1.126, HR = 3.084, 95% CI:1.157 ～8.221，P=0.024)和白蛋白(β=-0.099，HR=0.906，95% CI：0.836～0.9983，P=0.017)是患者生存的独立危险因素。结论 APD 治疗终末期DKD 患者的长期生存率优于CAPD，但透析方式并不是患者生存的独立影响因素。

关键词: 自动化腹膜透析, 糖尿病肾病

Abstract: 【Abstract】Objective To investigate the clinical characteristics, prognosis and the risk factors for longterm survival in end-stage renal disease patients including end-stage diabetic kidney disease patients treated with automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). Method This is a retrospective cohort study. Adult peritoneal dialysis patients (peritoneal dialysis over 3 months) from September 1st, 2002 to June 30th, 2018 were enrolled in this study. Their baseline data were collected. These patients were followed up to September 30th, 2018 and death was defined as end point. Survival of APD patients and CAPD patients, diabetic kidney disease (DKD) and non-DKD patients were compared. Univariate and multivariate Cox regression were used to identify the risk factors for long-term prognosis. Results A total of 534 PD patients (92 APD patients and 442 CAPD patients; 198 DKD patients and 336 non-DKD patients) were enrolled in this study. Compared to non-DKD patients, DKD patients were older with a higher ratio of cardiovascular disease. DKD patients started dialysis earlier (creatinine at the time of dialysis: DKD 620.4±228.9 vs. non-DKD 808.0±352.0μmol/L, t=-6.556, P＜0.001). The cumulative survival rate after 1, 3, 5, and 10 years were 92%, 78%, 65% and 42% respectively in APD patients, and were 83%, 65%, 42% and 22%, respectively in CAPD patients. APD patients had longer median survival time (92.3 months vs. 64.3 months, χ2=8.675, P=0.003). DKD patients had shorter median survival time than non-DKD patients (47.9 months vs. 92.3 months, χ2=46.379, P＜0.001), and DKD patients treated with CAPD had the shortest median survival time (45.2 months, χ2=55.545, P＜0.001). Multivariate Cox regression identified that age (β=0.086, HR=1.090, 95% CI 1.039-1.144, P＜0.001), diabetes (β =1.126, HR=3.084, 95% CI 1.157- 8.221, P=0.024) and albumin level (β =- 0.099, HR=0.906, 95% CI 0.836-0.9983, P=0.017) were the risk factors for all-cause mortality in APD patients. Conclusion DKD patients treated with APD showed better long-term survival than those treated with CAPD. However, APD itself may not be the independent impact factor for survival.

Key words: Automated Peritoneal Dialysis, Diabetic Kidney Disease