血液透析和腹膜透析患者死亡原因分析及比较

目的:分析血液净化患者的死亡原因,并比较血液透析(HD)和腹膜透析(PD)患者的死因差异.方法:纳入2005-01-01至2008-12-31期间新进入透析的患者,随访至2009-03-31.结果:460例透析患者中,247例起始采用HD治疗,213例起始采用PD治疗.HD组男性比例和血肌酐显著较高,而PD组基础疾病为高血压肾病比例显著较高,其余基线资料包括透始年龄、体重指数、透析前已知的肾功能不全病程、首次透析治疗前eGFR、平均动脉压、心脑血管事件、Charlson并发症指数等两组间均无明显统计学差异.共87例死亡患者,其中HD患者40例,PD患者47例.HD总体死亡率低于PD患者(0.102和0.171/患者年,P＜0.01).HD 1年死亡率与PD患者无显著差异(0.133和0.196/患者年,P＞0.05),HD 2年死亡率低于PD患者(0.101和0.170/患者年,P＜0.05),HD 3年死亡率低于PD患者(0.101和0.165/患者年,P＜0.05).透析患者的主要死亡原因为心血管疾病(31.0%)、脑血管疾病(21.8%)、感染(16.1%).PD患者心血管病因死亡率显著高于HD患者(0.064和0.022/患者年,P＜0.01),而两组的脑血管疾病、感染、多脏器衰竭和恶性肿瘤导致的死亡率均无显著差异.年龄＜65岁患者中,HD总体死亡率与PD无显著差异,两组患者的心血管疾病、脑血管疾病、感染、多脏器衰竭和恶性肿瘤死亡率均无显著差异.年龄≥65岁患者中,HD总体死亡率低于PD(0.179和0.378/患者年,P＜0.05),PD患者心血管疾病死亡率高于HD患者(0.164和0.004/患者年,P＜0.05),两组患者的脑血管疾病、感染、多脏器衰竭和恶性肿瘤死亡率均尤显著差异.透析龄≤1年患者中,HD总体死亡率与PD患者无显著差异;PD患者多脏器衰竭导致的死亡率显著高于HD患者(0.082和0.000/患者年,P＜0.05),而两组的心血管疾病、脑血管疾病、感染和恶性肿瘤导致的死亡率均无显著差异.透析龄＞1年患者中,HD总体死亡率与PD患者无显著差异;PD患者心血管病因死亡率高于HD患者(0.026和0.006/患者年,P＜0.05),感染导致的死亡率显著高于HD患者(0.013和0.000/患者年,P＜0.05),两组的脑血管疾病、多脏器衰竭、恶性肿瘤导致的死亡率均无显著差异.结论:透析患者最主要的死因为心、脑血管疾病和感染.HD总体死亡率可能低于PD,尤其是心血管疾病和感染导致的死亡率.应该强调透析患者的心脑血管并发症和感染的防治,以提高透析质量,改善长期预后.

Comparison of death causes between patients with hemodialysis and peritoneal dialysis

Objective:To analyse the causes of death in patients with blood purification and compare the differencet causes of death between patients treated with hemodialysis(HD)and peritoneal dialysis(PD).Methodology:The clinical data of incident patients stating dialysis between Jan.2005 and Dec.2008 was retrospectively analysed.All patients were followed up till Mar.2009.Results:A total of 460 dialysis patients was enrolled in this syudy.Among them,247 patients accepted HD treatment initially and others accepted PD.The proportion of males and serum ereatinin of HD patients were significantly higher than PD patients and the proportion of hypertensive nephropathy was significantly lower than PD patients.There was no significant difference of other baseline data such as age.body mass index,estimated glomerular filtration rate,the history of cerebrovascular and cardiovascular accident,and Charlson comorbidity index between patients on HD and PD at the beginning of dialysis.40 HD patients and 47 PD patients died during the study period.The overall mortality was significantly higher in PD patients than that in HD patients(0.171 and 0.102/patient years,P＜0.01).The 1-year survival rate of patients with HD and PD patients was similar(0.133 and 0.196/patient years,P ＞ 0.05),the 2 and 3-year survival rate of patients with HD was significantly lower than that with PD respectively(0.101 and 0.170,P ＜ 0.05 ; 0.101 and 0.165/patient years,P ＜ 0.05).The main causes of death in dialysis patients were cardiovascular disease(31.0%),cerebrovascular disease(21.8%)and infection(16.1%).The patients with PD had a higher mortality due to cardiovascular disease(0.064 and 0.022/patient years,P ＜ 0.01).There was no significant difference in mortality between HD and PD patients due to cerebrovascular disease,infection,multiple organ failure,and malignant tumor,while HD patients had a lower overall mortality(0.179 and 0.378/patient years,P ＜0.05)and mortality due to cardiovascular disease(0.004 and 0.164/patient years,P ＜0.05)in the patients 65 years of age or older.In the first 1 year of dialysis,PD patients had a higher mortality due to multiple organ failure(0.082 and 0.000/patient years,P ＜0.05)and no significant difference due to other causes compared with HDpatients.In the period over 1 year,the overall mortality was similar between patients with HD and PD,while patients with PD had a higher mortality due to cardiovascular disease(0.026 and 0.006/patient years,P ＜ 0.05)and infection(0.013 and 0.000/patient years,P ＜ 0.05).Conclusion:Cardiovascular and cerebrovascular disease,and infection are the main causes of death in dialysis patients.Patients with PD may have a higher mortality than that with HD,especially due to cardiovascular disease and infection.Prevention and treatment of cardio-cerebral vascular and infection complications of dialysis patients should be emphasized to improve the quality and long term prognosis of dialysis.