
植管后两周内开始腹膜透析与规律开始腹膜透析患者的预后比较
刘曜蓉 方炜 张琳 林爱武 倪兆慧 钱家麒
植管后两周内开始腹膜透析与规律开始腹膜透析患者的预后比较
Prognostic comparison of patients starting peritoneal dialysis within two weeks and more than two weeks after catheter implantation
目的 比较腹膜透析(腹透)植管后2周内开始腹透的患者与规律开始腹透患者的预后。 方法 入选2001年1月1日至2010年12月31日期间在本院腹透中心植入腹透管并开始腹透的所有年龄超过18岁的患者。所有患者随访至患者死亡、退出腹透、转其他中心、失访或至研究终止日期(2011年3月31日)。植管后2周内开始透析的患者定义为紧急透析组,超过2周开始透析的患者为规律透析组。采用Kaplan-Meier生存曲线、Log-rank检验比较两组患者的技术生存率、无腹膜炎生存率及患者生存率。 结果 研究期间共657例入选,其中紧急透析组469例(71.4%),植管至开始透析的中位时间为6 d;规律透析组188例(28.6%),植管至开始透析的中位时间为26 d。与规律透析组相比,紧急透析组患者较年轻[(52.6±17.3)比(56.1±15.3)岁,P=0.017];残肾功能较差[(5.36±2.03)比(6.50±2.50) ml•min-1•(1.73 m2)-1,P<0.01];血清白蛋白和血红蛋白较低[(34.0±5.7)比(36.2±5.9) g/L,P<0.01;(76.9±18.8)比(80.8±17.9) g/L,P=0.018];血磷较高[(2.19±0.67)比(1.98±0.52) mmol/L,P<0.01]。紧急透析患者因导管功能障碍转血透的比例高于规律透析患者(2.1%比0%,P=0.044)。紧急透析组和规律透析组的1、2、3、5年的技术生存率分别是94%和98%、92%和94%、90%和92%、86%和85%,两组各年技术生存率差异均无统计学意义(Log-rank=1.536,P=0.22)。两组的无腹膜炎生存率差异无统计学意义(Log-rank=0.035,P=0.85)。紧急透析组和规律透析组的1、2、3、5年的患者生存率分别是90%和95%、81%和90%、74%和79%、67%和74%,两组患者生存率差异无统计学意义(Log-rank=2.364,P=0.12)。 结论 虽然在腹透植管两周内开始透析的患者一般情况较规律透析患者差,但其预后与规律透析组患者相似。对转诊晚等原因需要紧急透析的患者,临床医生可根据具体情况在腹透植管后短期内开始腹透治疗。
Objective To compare the outcomes of patients starting peritoneal dialysis (PD) within two weeks and more than two weeks after catheter implantation. Methods All the patients undergoing Tenckhoff catheter implantation and initiating PD in Renji Hospital from January 2001 to December 2010 were enrolled in the study. Patients started PD within 2 weeks after catheter insertion were defined as urgent group, and those started PD 2 weeks later were defined as planned group. Kaplan?Meier curves and Log-rank tests were used to compare outcomes between two groups. Results Among 657 patients in this study, median break-in period was 6 days of 469 (71.4%) patients in urgent group and 26 days of 188 (28.6%) patients in planned group. Compared to planned group, patients of urgent group were younger [(52.6±17.3) vs (56.1±15.3) year, P=0.017], had less eGFR [(5.36±2.03) vs (6.50±2.50) ml•min-1•(1.73 m2)-1, P<0.01], lower serum albumin [(34.0±5.7) vs (36.2±5.9) g/L, P<0.01] and hemoglobin [(76.9±18.8) vs (80.8±17.9) g/L, P=0.018], and higher phosphate [(2.19±0.67) vs (1.98±0.52) mmol/L, P<0.01]. Urgent group presented more catheter dysfunctions needed to transfer to hemodialysis (2.1% vs 0%, P=0.044). The 1-, 2-, 3- and 5-year technique survival rates of urgent and planned group were 94% vs 98%, 92% vs 94%, 90% vs 92% and 86% vs 85% respectively. There was no significant difference in technique survival (Log-rank=1.536, P=0.22) and peritonitis?free survival (Log-rank=0.035, P=0.85) between two groups. The 1-, 2-, 3- and 5-year patient survival rates of urgent and planned group were 90% vs 95%, 81% vs 90%, 74% vs 79% and 67% vs 74% respectively, and no significant difference was found (Log-rank=2.364, P=0.12). Conclusions Although patients needing urgent initial PD have poorer residual renal function and nutritional condition compared to those of planned initial PD, their outcomes are similar. Peritoneal dialysis may be a feasible and safe dialysis modality for patients who need urgent start.
存活率分析; 腹膜透析; 导管 / 留置; 急诊处理 {{custom_keyword}} /
Survival analysis / Peritoneal dialysis / Catheters, indwelling / Emergence treatment {{custom_keyword}} /
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