腹膜透析患者退出原因分析及防治措施

目的通过分析持续性非卧床腹膜透析（continuousambulatoryperitonealdialysis，CAPD）患者退出腹膜透析者的原因并探讨相应对策。方法收集我院2009年4月至2013年2月因慢性肾衰竭（chronicrenalfailure，CRF）接受CAPD患者的临床资料，分析患者退出的各种原因及所占比例。具体分组如下：①按照退出原因进行分组，比较各组在透析前各项实验室指标、原发病因的差异；②按照腹膜透析患者的文化程度及医疗付费方式等情况进行分组，观察组间退出率有无差异。结果95例患者退出腹膜透析的有32例（退出率33．7％），退出原因为死亡17例（53．2％），经济困难放弃治疗5例（15．6％），转血液透析6例（18．8％），肾移植4例（12．4％），死亡原因主要为心脑血管事件和肺部感染；死亡组年龄明显高于其他组，而透析前残余肾功能显著低于对照组；初中及以上文化组（组1）共12例退出（退出率19．4％），明显低于初中以下文化组（组2）共20例退出（退出率60．6％），而医保患者的退出率（30．7％）明显低于自费组的退出率（75．8％）。结论死亡是CAPD患者短期内退出腹膜透析的主要原因，心脑血管事件、肺部感染是导致CAPD患者死亡的主要原因，而患者的文化程度及经济因素也是导致腹膜透析患者退出的重要原因，因此在积极加强透析前的系统治疗及透析后的持续合理管理之外，还应向患者反复讲解CAPD的正规操作方法及注意事项。

Peritoneal dialysis drop-out： causes and prevention strategies

Objective To discuss the countermeasures for the peritoneal dialysis drop-out by analy- zing the reason for patients drop out from continuous ambulatory peritoneal dialysis. Methods Collected the clinical dam of patients at our hospital who started with CAPD because of chronic renal failure from April, 2009 to February,2013 ,and analyzed the multiple reasons for dropouts and the proportions. Dropouts were divided into several groups： （1）Grouped them as the drop-out reasons and compared the laboratory data and primary diseases; （2）Grouped them as education or medical reimbursement, then compared the drop-out rate Results 32 patients dropped out from CAPD （total number of patients were 95, the drop-out rate was 33. 7% ）, 17 patients dropped out because of death（the death group drop-out rate was 53. 2% ）, 5 patients gave up their medical treatment because of financial problems（the give-up group drop-out rate was 15. 6%） ,6 patients transferred to HD（hemodialysis, HD, the transferred group drop-ont rate was 18. 8%）, 4 patients ac- cepted renal transplantation（the transplantation group drop-out rate was 12. 4% ）. The cardio-cerebrovascular events and the pulmonary infection were the major reasons for death group drop-out. Compared to other groups, the age in death group were much higher, but the rest renal function were much lower. There were 12 patients dropped out from the group one（who received the junior high school education or above it, the drop- out rate was 19.4 0% ）, which was much lower than the group two（who received the under junior high school education, the drop-out rate was 60. 6%）. The drop-out rate in patient who had the medical insurance （30. 7%） was much lower than the self-paying group （75.8%）. Conclusions The major drop-out reason for CAPD was death in short terlIX Cardio-cerebrovascular events and the pulmonary infection were the major reason for CAPD patient death. The degree of education and the financial factors were the key reasons why peritoneal patients dropped out. Besides enhancing the pre-dialysis systemic treatment and continuous manag- ing,we also needed to focus on explaining the standard operation methods and the announcements of the CAPD over and over again.