腹膜炎发生频率对腹膜透析患者生存的影响

doi:10.3969/j.issn.1671-4091.2022.03.003

摘要/Abstract

摘要： 【摘要】目的本研究通过对腹膜透析患者长期随访队列的生存分析，探讨腹膜炎发生频率对腹膜透析患者长期生存的影响。方法研究对象为2006 年1 月～2014 年4 月新进入腹膜透析治疗的成人(年龄≥18 岁)终末期肾病患者，随访截止时间为2020 年12 月。应用COX 回归模型分析影响生存率的因素。按患者腹膜炎发生频次分为3 组：A 组(＜0.2 次/年)；B 组(0.2～0.5 次/年)；C 组(＞0.5 次/年)。应用Kaplan-Meier生存分析、COX回归模型分析比较3 组患者的生存情况。结果共221例腹膜透析患者入选。经过多因素COX 回归，患者年龄(HR=1.058,95% CI:1.040～1.076, P＜0.001)、Charlson 合并症指数(HR=1.274, 95% CI:1.107～1.466, P= 0.001)、时间平均全段甲状旁腺激素(iPTH) (HR=0.998,95%CI:0.996～0.999,P =0.001)和腹膜炎发生频率(HR=3.301,95% CI:2.098～5.196, P＜0.001)是预测死亡的独立危险因素。腹膜炎发生频率不同的3 组间总体生存率存在差异(χ2=99.473，P＜0.001)，C 组死亡风
险高于A 组(HR=2.022，95% CI:1.184～3.452，P=0.010)；高于B 组(HR=3.450，95% CI:1.723～6.906，P＜0.001)；而A 组、B 组死亡风险无差别(HR =1.013，95% CI:0.621～1.652，P=0.958)。结论腹膜透析治疗中，腹膜炎发生频率可以影响患者生存。但其影响存在阈值，当腹膜炎发生频率超过0.5 次/年时，患者死亡风险增加。

关键词: 腹膜透析, 腹膜炎, 生存率

Abstract: 【Abstract】Objective To investigate the effect of peritonitis frequency on survival rate of peritoneal dialysis patients. Methods The subjects were adult patients with end- stage renal disease (aged ≥ 18 years) newly admitted to peritoneal dialysis from January 2006 to April 2014. They were followed up till December 2020. COX regression model was used to analyze the related factors of all-cause death. The patients were divided into three groups according to the frequency of peritonitis: group A (＜0.2 episode/ year), Group B(0.2～0.5 episode/year), and Group C (＞0.5 episode/year). Kaplan-Meier survival analysis and COX regression
model were used to analyze the survival rate of the three groups. Results A total of 221 peritoneal dialysis patients were enrolled. After multivariate COX regression, the patients' age (HR=1.058, 95% CI 1.040～1.076，P＜0.001), Charlson complication index (HR=1.274, 95% CI 1.107～1.466, P = 0.001), time-averaged iPTH (HR=0.998, 95% CI 0.996～0.999, P=0.001) and the frequency of peritonitis (HR=3.301, 95% CI 2.098～5.196,P＜0.001) were independent risk factors for predicting death. The overall survival rate was different among the three groups (χ2=99.473，P＜0.001). The risk of death in group C was higher than that in group A (HR=2.022, 95% CI 1.184～3.452, P=0.010), and group B (HR=3.450, 95% CI 1.723～6.906, P＜0.001). But the risk of death was no difference between group A and group B (HR=1.013, 95% CI 0.621～1.652, P=0.958). Conclusion The frequency of peritonitis can affect the survival of patients with peritoneal dialysis. However, there is a threshold for its impact: when the frequency of peritonitis exceeds 0.5 episode/year, the risk of death increases.

Key words: Peritoneal dialysis, Peritonitis, Survival rate

中图分类号:

R459.5

武蓓, 赵慧萍, 王梅, 芦丽霞, 乔婕, 门春翠, 楚新新, 何玉婷. 腹膜炎发生频率对腹膜透析患者生存的影响[J]. 中国血液净化, 2022, 21(03): 153-157.

参考文献

参考文献
[1]Li P K , Szeto C C , Piraino B , et al. ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment[J]. Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis, 2016, 36(5).
[2]Heaf J G , L?kkegaard Hans, Melvin M . Initial survival advantage of peritoneal dialysis relative to haemodialysis[J]. Nephrology Dialysis Transplantation2002, 17(1):112-117.
[3]Johansen K L , Chertow G M , Foley R N , et al. US Renal Data System 2020 Annual Data Report: Epidemiology of Kidney Disease in the United States[J]. American Journal of Kidney Diseases, 2021, 77(4):A7-A8.
[4]徐冷楠, 陈献广, 李天慧,等. 单中心20年间维持性血液透析患者死亡原因分析[J]. 中华老年医学杂志, 2018, 37(10):1111.
[5]Zhang Q , Ren H , Xie J , et al. Causes of death in peritoneal dialysis patients with different kidney diseases and comorbidities: a retrospective clinical analysis in a Chinese center[J]. International Urology & Nephrology, 2014, 46(6):1201-1207.
[6]EMD Bustillo, F Borrás, C Gómez-Roldán, et al. Impact of peritonitis on long-term survival of peritoneal dialysis patients[J]. Nefrología Publicación Oficial De La Sociedad Espaola Nefrologia, 2011, 31(6):723-32.
[7]Tian Y , Xie X , Xiang S , et al. Risk factors and outcomes of high peritonitis rate in continuous ambulatory peritoneal dialysis patients: A retrospective study[J]. Medicine, 2016, 95(49):e5569.
[8]王丽, 章倩莹, 林涛, et al. 腹膜炎是腹膜透析患者全因死亡及心血管死亡的独立危险因素[J]. 上海交通大学学报(医学版), 2019, 39(9).
[9]Klari D , Knotek M . Long-term effects of peritonitis on peritoneal dialysis outcomes[J]. International Urology & Nephrology, 2013, 45(2):519-525.
[10][1] Hsieh Y P , Chang C C , Wen Y K , et al. Predictors of Peritonitis and the Impact of Peritonitis on Clinical Outcomes of Continuous Ambulatory Peritoneal Dialysis Patients in Taiwan--10 Years’ Experience in a Single Center[J]. Peritoneal Dialysis International, 2014, 34(1):85-94.
[11]Wei F , Ni Z , Qian J . Key factors for a high-quality peritoneal dialysis program--the role of the PD team and continuous quality improvement.[J]. Peritoneal Dialysis International Journal of the International Society for Peritoneal Dialysis, 2014, 34(Supplement 2):S35-S42.
[12]Nishina M , Yanagi H , Kakuta T , et al. A 10-year retrospective cohort study on the risk factors for peritoneal dialysis-related peritonitis: a single-center study at Tokai University Hospital[J]. Clinical & Experimental Nephrology, 2014, 18(4):649-654.
[13]Ghali J R , Bannister K M , Brown F G , et al. Microbiology and outcomes of peritonitis in Australian peritoneal dialysis patients[J]. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 2011, 31(6):651.
[14]Fai L M , Leung J C K , Kei L W , et al. Hyperleptinaemia and chronic inflammation after peritonitis predicts poor nutritional status and mortality in patients on peritoneal dialysis[J]. Nephrol Dial Transplant(5):1445-1450.
[15]Chen J H C , Johnson D W , Hawley C , et al. Association between causes of peritoneal dialysis technique failure and all-cause mortality[J]. Scientific Reports, 2018, 8(1):3980.