中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (12): 801-805.doi: 10.3969/j.issn.1671-4091.2018.12.003

• 临床研究 • 上一篇    下一篇

腹膜透析在慢性肾脏病急性加重治疗中的应用

严豪1,李振元1,金海姣1,俞赞喆1,张贺1,方炜1,倪兆慧1   

  1. 1. 上海交通大学医学院附属仁济医院肾脏科 上海腹膜透析研究中心(严豪1、李振元1为共同第一作者)
  • 收稿日期:2018-07-23 修回日期:2018-08-10 出版日期:2018-12-12 发布日期:2018-12-19
  • 通讯作者: 方炜 fangwei_sh@126.com 倪兆慧 profnizh@126.com E-mail:profnizh@126.com
  • 基金资助:

    上海市卫生和计划生育委员会科研课题(201740037) 上海市浦江人才计划上海交通大学医学院 附属仁济医院临床科研创新培育基金(PYIII-17-009)

Utilization of peritoneal dialysis in acute kidney failure on chronic kidney disease

  • Received:2018-07-23 Revised:2018-08-10 Online:2018-12-12 Published:2018-12-19

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摘要： 【摘要】目的观察腹膜透析治疗慢性肾脏病急性加重的疗效。方法纳入2013 年3 月～2016 年2 月期间在上海交通大学医学院附属仁济医院因发生慢性肾脏病急性加重而行腹膜透析的病例并前瞻性随访2 年，观察肾功能恢复、患者生存、腹膜炎等情况。结果共23 例患者入选，其中男性14 例(60.9%)，中位年龄68 岁。至随访结束，11 例(47.8%)患者肾功能恢复脱离透析、5 例(21.7%)死亡、1 例(4.3%)失访、6 例(26.1%)维持腹膜透析治疗。该群患者的平均腹膜炎发生率为1 次/38.9 患者每月。相对于其他患者，肾功能恢复患者的基础肾脏病病因不同 (x2 = 18.381, P = 0.031)，基础肾功能水平处于CKD1～3 期的比例较高 (x2 = 11.967, P= 0.001)，合并心脑血管疾病(x2=11.294，P= 0.001)和糖尿病(x2=5.977，P =0.014)较少，Charlson 合并症指数较低(Z=-2.128，P=0.033)，开始透析时血浆B 型脑钠肽较低(Z=-2.985，P=0.003)而血肌酐较高(t=2.103，P =0.048)，其平均腹膜透析维持时间(5.4±4.3)月(范围10 天～13.3月)。结论腹膜透析可作为需要肾脏替代治疗的慢性肾脏病急性加重患者的治疗选择。

关键词: 腹膜透析, 慢性肾脏病, 急性肾损伤, 慢性肾脏病急性加重

Abstract: 【Abstract】Objective To evaluate the effect of peritoneal dialysis (PD) in acute kidney injury on chronic kidney disease (AKI on CKD). Methods Patients undergoing PD due to AKI on CKD in Renji Hospital, School of Medicine, Shanghai Jiao Tong University between March 2013 and February 2016 were enrolled and prospectively followed up for 2 years. Results A total of 23 patients (14 males; median age 68 years) were enrolled. By the end of the study, PD terminated and renal function recovered in 11 patients (47.8%), 5 patients (21.7%) died, follow-up lost in one patient (4.3%), and PD continued in 6 patients (26.1%). Prevalence of peritonitis in this cohort was 1 episode/38.9 patient-months. CKD etiology differed among patients with and without renal recovery (x2=18.381, P=0.031). In patients with renal recovery, preexisting CKD at stage 1-3 was more prevalent (x2=11.967, P=0.001); cardiovascular disease (x2=11.294, P=0.001) and diabetes mellitus (x2=5.977, P=0.014) were less prevalent; additionally, they had lower Charlson comorbidity index scores (Z=-2.128, P=0.033), lower plasma BNP (Z=-2.985, P=0.003) and higher serum creatinine (t=2.103, P=0.048) at the beginning of PD; Average PD vintage was 5.4±4.3 months (10 days~13.3 months). Conclusions PD can be used as a renal replacement therapy in AKI on CKD.

Key words: Peritoneal dialysis, Chronic kidney disease, Acute kidney injury, Acute kidney injury, Acute deterioration on chronic kidney disease