血液透析和腹膜透析患者生存比较

目的 比较血液透析和腹膜透析患者的生存情况，探讨影响透析患者生存的主要危险因素。 方法 研究对象为2005年1月1日至2008年12月31日期间新进入透析且年龄≥18岁患者，随访至2009年3月31日。应用Kaplan-Meier法、log-rank检验及Cox回归模型分析患者的生存资料。 结果 共460例透析患者入选，其中247例起始采用血透治疗，213例起始采用腹透治疗。两组患者的基线资料，包括开始透析年龄、体质量指数（BMI）、估算肾小球滤过率（eGFR）、平均动脉压、进入透析治疗前心脑血管事件、Charlson并发症指数（CCI）等的差异均无统计学意义。中位随访时间为17.9（0.25，51）个月。意向治疗分析结果中，Kaplan-Meier生存曲线显示血透总体生存率优于腹透（P ＜ 0.05，log-rank检验）；透析1年内两组生存率差异无统计学意义（P = 0.14），而透析1年后腹透患者的生存率显著低于血透患者（P ＜ 0.05）。亚组分析结果显示，≥65岁的非糖尿病肾病血透组生存率显著高于腹透组（P ＜ 0.05）。Cox回归分析显示，经混杂因素调整后，两种透析方式本身对透析生存无明显影响（HR，HD：PD = 0.778，95%CI 0.483~1.254，P = 0.303）；而年龄（HR = 1.051，95%CI 1.030~1.073，P ＜ 0.01）、透前有脑血管意外史（HR = 2.032，95%CI 1.125~3.670，P ＜ 0.05）、透前CCI≥5（HR=2.592，95%CI 1.230~5.465，P ＜ 0.05）、前白蛋白（HR = 0.022，95%CI 0.001~0.768，P ＜ 0.05）为透析患者生存率的主要影响因素。 结论 透析龄≤1年的血透和腹透生存率无显著差异；透析龄>1年的血透患者生存率可能逐渐高于腹透患者。老年非糖尿病患者血透生存率可能高于腹透。年龄、透前脑血管意外史、透前CCI≥5为影响透析生存率的主要危险因素。

Comparison of survival in patients on hemodialysis and peritoneal dialysis

Objective To compare survival in patients on hemodialysis(HD)and peritoneal dialysis(PD)and to explore the main risk factors affecting survival of dialysis. Methods The data of initial dialysis patients of 18 years or older between 1 January 2005 and 31 December 2008 were analyzed retrospectively.All the patients were followed up until 31 March 2009.Survival analysis was performed using Kaplan-Meier method,log-rank test and Cox regression model.Results A total of 460 dialysis patients were enrolled,among whom 247 patients received HD therapy and 213 patients received PD therapy.There was no significant difference of age,body mass index(BMI),estimated glomerular filtration rate(eGFR),mean arterial pressure (MAP)at the beginning of dialysis and the history of cerebrovascular accident,Charlson comorbidity index(CCI)before dialysis between patients on HD and PD(all P>0.05).The median follow-up time was 17.9(0.25-51)months.By analysis of treatment intention,Kaplan-Meier survival curve revealed that overall mortality rate was significantly lower in HD group(P<0.05,log-rank test).Mortality of two groups was similar in the first 1 year(P=0.14,log-rank test).In the period beyond 1 year,there was a significantly higher mortality in PD group.Sub-group analysis revealed that survival was better in non-diabetic nephropathy(non-DN)patients older than 65 years on HD(P<0.05).After the adjustment of case-mix differences,the Cox regression model indicated that there was no significant difference of survival between HD and PD patients[HR(HD:PD)=0.778,95%CI 0.483-1.254,P=0.303],while age(HR=I.051,95%CI 1.030-1.073,P<0.01),history of cerebrovascular accident before dialysis(HR=2.032,95%CI 1.125-3.670,P<0.05),CCI ≥5 before dialysis(HR= 2.592,95%CI 1.230-5.465,P<0.05),prealbumin(HR=0.022,95%CI 0.001-0.768,P<0.05)were the main risk factors of survival in dialysis.Conclusions Survival is similar between HD and PD patients in the first 1 year of dialysis.In the period beyond 1 year,mortality of PD patients is significantly higher.Survival is better in non-DN patients older than 65 years.Age,history of cerebrovascular accident and CCI≥5 before dialysis may be the main risk factors of survival in dialysis.