摘要
目的比较自动化腹膜透析（APD）与持续非卧床腹膜透析（CAPD）的终末期肾病患者临床特点和预后，探讨影响自动化腹膜透析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日至2016年9月30日期间于北京协和医院开始腹膜透析的患者，采集患者进入腹膜透析时的基线资料，随访至2016年12月3113。以死亡为观察终点，以同期性别年龄匹配的CAPD患者作为对照，评价APD患者的生存，并进行单因素及多因素Cox回归分析。结果与同期138例CAPD患者相比，69例APD患者的基线资料并无差异。APD患者1年、3年和5年生存率分别为95．4％、88．0％和73．0％，显著优于同期CAPD组患者（Logrank检验，P=0．007），二者的技术生存率差异无统计学意义。单因素Cox回归分析显示，CAPD全因死亡风险是APD的2．2倍（95％CI1．221～3．837），多因素回归分析显示透析方式不是影响腹透患者全因死亡的独立因素。APD患者中，年龄（HR=1．077，95％CI1．016～1．142，P=0．013）、糖尿病（HR=3．608，95％CI1．117～11．660，P=0．032）和白蛋白水平（HR=0．890，95％C10．808～0．982，P=0．020）是全因死亡的独立影响因素。结论透析方式不是影响腹膜透析患者长期生存的独立影响因素，而透析开始时的年龄、糖尿病和低蛋白血症是APD患者死亡的独立危险因素。
Objectives To compare the clinical characteristics, long- term survival and associated risk factors of automated peritoneal dialysis （APD） patients and continuous ambulatory peritoneal dialysis （CAPD） patients. Methods As a retrospectively study, adult patients started peritoneal dialysis in Peking Union Medical College Hospital （PUMCH） from September 1^st, 2002 to September 30^th, 2016 were enrolled. Baseline information and dialysis associated parameters were collected. The primary outcome was death and the secondary outcome was technical failure. The risk factors of death were analyzed in APD patients by Cox＇s regression model. Homochromous gender and age matched CAPD patients were analyzed as control. Results The baseline condition of 69 APD patients were similar to those of 13g CAPD patients. The survival rates of APD patients at 1-year, 3- year and 5-year were 95.4%, 88.0% and 73.0% respectively, which were superior to CAPD patients. No significant difference in technical survival was found between APD and CAPD patients. Singlefactor Cox＇s regression analysis showed that all-cause mortality of CAPD patients was 2.2 times higher than that of APD patients （95% CI 1.221-3.837）. In the multi-factor Cox regression analysis model, adjusted by age, complications （including cardiovascular disease and diabetes）, nPCR and serum creatinine, dialysis modality was not an independent risk factor of dialysis patients. Age （HR=l.077, 95%CI 1.016- 1.142, P=0.013）, diabetes （HR=3.608, 95%CI 1.117- 11.660, P=0.032） and serum albumin （HR=0.890, 95%CI 0.808-0.982, P=0.020） were independently associated with all-cause death of APD patients. Conclusions Dialysis modality was not an independent risk factor for the all- cause mortality of peritoneal dialysis patients. Age, diabetic nephropathy and hypoalbuminemia were independently associated with the death of APD patients.
出处
《中华肾脏病杂志》
CSCD
北大核心
2017年第10期738-744,共7页
Chinese Journal of Nephrology
基金
中国医学科学院医学与健康科技创新工程（2016-12M-2-004）
中国医学科学院协和学者特聘教授基金
关键词
腹膜透析
持续不卧床
肾功能衰竭
慢性
存活率分析
Peritoneal dialysis, continuous ambulatory
Kindney failure, chronic
Survival analysis
