辅助腹膜透析的预后分析

目的比较辅助腹膜透析和自主腹膜透析对腹膜透析(peritoneal dialysis,PD)患者的预后影响。方法回顾性收集1996年3月13日至2016年12月31日在北京协和医院行PD且资料完整的637例成人患者的临床资料,按照患者是否独立完成PD操作将将患者分为自主PD组和辅助PD组,按照PD的模式不同进一步将辅助PD组分为自动化腹膜透析组(automated peritoneal dialysis,APD)和持续非卧床腹膜透析组(continuous ambulatory peritoneal dialysis,CAPD),分别比较辅助PD和自主PD两组间以及辅助APD和辅助CAPD两组间患者生存、技术生存及无腹膜炎生存方面的差异。结果本研究纳入辅助PD组373例(APD 35例,CAPD 338例),自主PD组264例。与自主PD相比,辅助PD患者年龄更大,合并糖尿病、高血压及心血管疾病比例更高,透析开始时血白蛋白、钾、磷、血肌酐、尿素、甲状旁腺素和标准蛋白分解率更低,而血二氧化碳总量和估算肾小球滤过率更高。辅助APD组与辅助CAPD组比较则前者合并心血管疾病比例,护工辅助比例以及透析3个月后残余肾功能水平更高。辅助PD组患者生存不及自主PD组,但经多因素校正后辅助PD不是患者死亡的独立危险因素(HR1.479,95%CI 0.978~2.236,P=0.064),两组在技术生存及无腹膜炎生存方面相当。辅助APD与辅助CAPD比较,两组的患者生存、技术生存及无腹膜炎生存均无差异。结论辅助PD的患者生存劣于自主PD,而技术生存及无腹膜炎生存两组无差异。辅助APD的患者生存、技术生存和无腹膜炎生存与辅助CAPD无差异,可以作为有需求患者的治疗选择。

The prognosis of assisted peritoneal dialysis

Objective To investigate the effect of assisted peritoneal dialysis(PD)and self-care peritoneal dialysison the prognosis of PD patients.Methods This retrospective study enrolled 637 adult patients started PD in Peking Union Medical College Hospital(PUMCH)from March 13,1996,to December 31,2016,and their clinical data were collected.Patients were divided into assisted and self-care PD groups according to the independence of manipulation of PD.In the assisted PD group patients were further divided into automated peritonealdialys(APD)and continuous ambulatory peritoneal dialysis(CAPD)groups according to different PD modes.Technique survival,peritonitis-free survival,and patient survival were compared between groups.Results Of the 637 patients,373 patients(35 with APD and 338 with CAPD)needed assistance.Assisted PD patients had older ages,a higher proportion of complications including diabetes,hypertension and cardiovascular diseases,higher levels of serum total carbon dioxide(TCO2)and estimated glomerular filtration rate(eGFR),but lower levels of serum albumin,potassium,phosphorus,creatinine,urea and parathyrin,and normalized protein catabolic rate(nPCR),compared to self-care PD patients.Assisted APD patients had a higher proportion of complications of cardiovascular diseases,a higher proportion of patient care need,and a higher residual kidney function at 3 months after PD initiation,compared to assisted CAPD patients.A worse survival was observed in the assisted PD patients than in the self-care PD ones;however,after multi-factor correction,assisted PD was not the independent risk factor for mortality(HR1.479,95%CI 0.978~2.236,P=0.064).Assisted PD and self-care PD patients had similar technique survival and peritonitis-free survival.Assisted APD and assisted CAPD patients had comparable patient survival,technique survival,and peritonitis-free survival.Conclusions Patient survival is worse in assisted PD patients,compared to self-care PD patients.There is no difference in technique survival and peritonitis-free survival between the two groups.APD patients have comparable patient survival,technique survival and peritonitis-free survival to assisted CAPD ones,and so assisted APD is a viable alternative for patients in need.