| 单中心腹膜透析患者的转归及其退出原因分析 |
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| 引用本文： | 沈水娟,王时敏,官继超,董志超,李青华,汪艳艳,杨燕茹,单娟萍.单中心腹膜透析患者的转归及其退出原因分析[J].中华全科医学,2019,17(8):1331-1334. |
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| 作者姓名： | 沈水娟 王时敏 官继超 董志超 李青华 汪艳艳 杨燕茹 单娟萍 |
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| 作者单位： | 绍兴市人民医院 浙江大学绍兴医院肾内科, 浙江 绍兴 312000 |
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| 基金项目： | 浙江省医药卫生一般研究计划项目(2016KYB303)；绍兴市科技计划项目(2015B70047) |
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| 摘 要： | 目的通过分析腹膜透析(peritoneal dialysis,PD)患者退出腹膜透析的原因并探讨相应对策。方法收集绍兴市人民医院腹膜透析中心2005年8月-2018年3月因慢性肾衰行腹膜透析成人患者的临床资料,统计退出腹膜透析患者的例数,并分析退出原因。结果共299例入组,其中156例仍在本院腹透,143例PD转出本院腹透随访系统,因地域或医保原因转院69例(48.3%),改血透30例(21.0%),行肾移植16例(11.2%),死亡28例(19.6%)。首位死亡原因是心脑血管病12例(42.9%),营养不良6例(21.4%),感染和肿瘤各5例(17.9%)。与对照组比,移植组患者TC、LDL和DBP更高,总Kt/v更低;转血透组患者BUN、PTH更高,残肾Kt/v与总Kt/v更低;死亡组患者Alb、PTH、Scr、DBP、残肾Kt/v与总Kt/v更低,TC、TG与LDL更高(均P<0.05)。Logistic分析残肾Kt/v与是否转血透呈负相关,即Kt/v越小,越容易转血透(P<0.05)。COX生存分析发现,初次腹透年龄大、CRP、血钙和血磷水平高、Scr及残肾Kt/v水平低均是影响腹透患者死亡的危险因素。结论腹膜透析患者退出腹膜透析的最常见原因是改血透,其次是死亡。而腹膜炎是改血透的最常见原因,死亡最常见原因是心脑血管疾病,其次是营养不良。置管时残肾Kt/v越小,越容易转血透。故适时透析、规范操作、改善营养、控制心血管高危因素等是提高腹膜透析患者长期生存的措施。
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| 关 键 词： | 腹膜透析 肾功能衰竭 退出 死亡 |
| 收稿时间： | 2018-09-15 |
The analysis of outcomes and dropout causes in peritoneal dialysis patients in a medical center |
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| Affiliation: | Nephrology Department of Shaoxing People's Hospital(Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang 321000, China |
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| Abstract: | Objective To discuss the countermeasures for the peritoneal dialysis (PD) drop-out by analyzing the reason for the patients who have withdrawn from PD. Methods The clinical data of patients at our hospital who started with PD because of chronic renal failure from August 2005 to March 2018 were collected，and the proportions and reasons for dropouts were analyzed. Results A total of 299 patients were recruited in this study. Among them, 143 cases were transferred out of the follow-up system of PD. In detail, 69 cases (48.3%) were transferred to other hospitals for regional or medical reasons, 30 cases (21.0%) were switched to hemodialysis (HD), 16 cases (11.2%) underwent kidney transplantation, and 28 cases (19.6%) died. The first cause of death was cardiovascular and cerebrovascular events (12 cases, 42.9%)，followed by malnutrition (6 cases, 21.4%), infection (5 cases, 17.9%) and tumor factors (5 cases, 17.9%). Higher levels of TC, LDL,DBP and lower levels of total kt/v were found in patients switcher to HD, while higher levels of CRP and PTH, as well as lower levels of residual renal kt/v and total kt/v, were found in patients who switched to HD compared with patients still undergoing PD. Moreover, in death group, patients had significant lower levels of Alb, PTH, DBP, Scr, residual renal Kt/v and total Kt/v, and higher levels of TC, TG and LDL (all P＜0.05). Logistic analysis showed that residual renal Kt/v was inversely correlated with possibility for patients switching to HD (P＜0.05). Cox analysis showed that advanced strating age of PD, high levels of serum CRP, calcium and phosphorus, and low levels of Scr and residual kidney Kt/v were risk factors for mortality in PD patients. Conclusion changing from PD to hemodialysis is the most common cause of dropout in PD patients,followed by death. Peritonitis is the main cause in patients change to HD.cardiac-cerebral vascular is the major cause for death, followed by malnutrition.the lese residual renal Kt/v at the time of catheterization, the easier it is to transfer hemodialysis. Therefore, timely dialysis, standard operation, improvement of nutrition, and control of cardiovascular risk factors are measures to improve the long-term survival of peritoneal dialysis patients. |
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| Keywords: | Peritoneal dialysis Kidney failure Dropout death |
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