中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (05): 238-342.doi: 10.3969/j.issn.1671-4091.2013.05.00

• 临床研究 • 上一篇    下一篇

终末期糖尿病肾病血液透析和腹膜透析预后的比较研究

李慧凛,齐尔,蒋更如   

  1. 上海交通大学医学院附属新华医院肾内科
  • 收稿日期:2012-07-23 修回日期:2012-10-25 出版日期:2013-05-12 发布日期:2013-07-01
  • 通讯作者: 蒋更如 jianggeng-ru@hotmail.com E-mail:jianggeng-ru@hotmail.com

A comparative study of the prognosis in end-stage diabetic kidney disease patients treated with hemodialysis and those treated with peritoneal dialysis

  • Received:2012-07-23 Revised:2012-10-25 Online:2013-05-12 Published:2013-07-01

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摘要： [摘要] 目的 回顾性观察血液透析和连续非卧床腹膜透析两种不同方式对终末期糖尿病肾病患者临床预后及生存率的影响。方法 收集2007年1月～2012年5月在上海交通大学医学院附属新华医院接受血液透析（HD，n=73）和连续非卧床腹膜透析（CAPD，n=42）治疗的终末期糖尿病肾病患者的临床资料，排除透析时间<3月者，比较两组患者首次透析前及观察期终止时的各项临床指标、并发症、生存率、死因等情况。结果 HD与CAPD两组在首次透析年龄、血肌酐、尿素氮、肾小球滤过率、血红蛋白、血白蛋白、血尿酸等基线特征上无显著差异（P＞0.05）；在观察期终止时血红蛋白、血钙、血磷、iPTH水平均无显著性差异（P＞0.05），而HD组血浆白蛋白水平显著高于CAPD组（P＜0.05），HD组血浆白蛋白水平较首次透析前显著性升高（P＜0.05）；HD组发生心功能不全、出血事件、脑梗塞的比例较CAPD组显著升高，差异具有显著性（P<0.05）；二者感染患病率相似，差异无显著性（P＞0.05）；HD与CAPD两组死亡率无显著性差异，主要死亡原因为心衰、重度感染、出血和脑血管病，死因构成上两组比较无显著性意义（P＞0.05）；CAPD组1、3、5年生存率均显著高于HD组（P<0.05），但首次透析年龄≥65岁的CAPD组1、3、5、7年生存率均显著低于HD组（P<0.05）。结论 本研究群体中，年龄<65岁的终末期糖尿病肾病患者CAPD 5年内生存率优于HD，而年龄≥65岁的患者宜选择HD方式，其生存率优于CAPD

关键词: 糖尿病肾病, 终末期肾病, 血液透析, 腹膜透析

Abstract: [Abstract] Objectives To investigate the clinical outcome and survival rate of diabetic end stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD) or maintenance hemodialysis (HD). Methods Our retrospective study collected datas included 115 dialysis patients secondary to diabetic nephropathy (73 on HD, 42 on CAPD) treated in Xinhua hospital during the period between January 2007 and May 2012. Patients on dialysis for less than 3 months were excluded. We compared the clinical parameters, complications, survival rate, mortality and its causes between HD and CAPD groups before and after dialysis. Results There were no significant differences in the baseline characteristics between the two groups of pre-dialysis patients, such as age when first dialysis, serum creatinine, blood urea nitrogen, glomerular filtration rate, hemoglobin, serum albumin, uric acid (P＞0.05). There were no significant differences in the level of hemoglobin, serum calcium, phosphorus and iPTH between the two groups at the end time of observation (P＞0.05), while the level of Serum albumin were significantly higher in HD group compared with CAPD group (P＜0.05). The level of serum albumin was significantly increased in HD group at the end time of observation(P＜0.05). The incidence of cardiac insufficiency, bleeding events, cerebral infarction were higher in HD patients than in CAPD patients (P＜0.05), while the incidence of infection was similar(P＞0.05). There were no significant differences on mortality rate between the two groups (P> 0.05). The main causes of death in two groups were heart failure, severe infections, bleeding and cerebrovascular disease. There were no statistically significant differences in the causes of death constitution (P>0.05). 1-, 3-,5-year survival rate in CAPD group were significant higher than HD group (P＜0.05). When performed subgroup analysis, 1-, 3-,5-, 7-year survival rate of CAPD patients with age≥65 years were significant lower compared with HD patients (P＜0.05). Conclusion In this study, CAPD has demonstrated 5 year-survival advantages over HD in the younger diabetic ESRD patients (less than 65 years old). HD elderly patients (above 65 years old) have better survival than CAPD patients, then HD may be a better dialysis modality for elderly diabetic ESRD patients.

Key words: Diabetic kidney disease, End-stage renal disease, Hemodialysis, Continuous ambulatory peritoneal dialysis