153例腹膜透析患者死亡及危险因素分析

目的分析腹膜透析患者死亡及其危险因素。方法对河北医科大学第三医院1997至2011年透龄6个月以上的153例CAPD患者进行回顾性分析,采用多变量Cox回归分析方法分析透析患者各临床指标对预后的影响。结果原发病病因中糖尿病肾病患者病死率最高（72．09％,31／43）,其次为缺血性肾病（60．00％,6／10）;死因中主要为心力衰竭（28．99％,20／69）,其次为脑血管意外（17．39％,12／69）。与存活组比较,死亡组血红蛋白（Hb）、血浆白蛋白（Alb）和总尿素清除指数（Kt/V）明显降低;年龄、脉压差、血磷及IyrH水平明显升高,差异均有统计学意义（均P〈0．05）。Cox回归分析结果显示患者年龄、总KdV、血磷、Hb、Alb水平对腹膜透析6个月以上死亡患者的相对危险度分别为1．188,0．798,2．308,2．102,O．898,均有统计学意义。结论透析初期患者年龄、Kt／V、血磷、Hb、Alb水平是CAPD死亡的独立危险因素。心脑血管疾病是CAPD患者的主要死因。

Mortality and risk factors of 153 patients on continuous ambulatory peritoneal dialysis

Objective To analyze the risk factors and mortality of patients on continuous ambulatory peritoneal dialysis （CAPD）. Methods A retrospective analysis was performed in 153 patients receiving CAPD for 〉6 months The Third Hospital, Hebei Medical University, between 1997 and 2011. The impact of clinical indices on the prognosis were determined via Cox regression analysis. Results Of all the primary causes, diabetic nephropathy （72.09%, 31/43） accounted for the highest proportion, followed by ischemic nephropathy （60.00% , 6/10）. The cause of death was predominated by heart failure （28.99% , 20/69） , followed by cerebrovascular events （17.39% , 12/69）. The patients who subsequently died were featured by impressively lower levels of hemoglobin, serum albumin and total Kt/V, and considerably higher levels of pulse pressure, serum phosphate, and parathyroid hormone （all P〈0.05）. Age, total Kt/V, serum phosphorus, hemoglobin and serum albumin yielded an OR of 1.188, 0.798, 2.308, 2.102 and 0.898 in dead patients although having received CAPD for 〉6 months （all P〈0.05）, as suggested by Cox regression analysis. Conclusion Cardiocerebro vascular event is the leading cause of death in CAPD patients, while age, total Kt/V, serum phosphorous, hemoglobin and serum albumin are independent risk factors of mortality in patients initially received CAPD.