糖尿病肾病腹膜透析患者的临床特点和预后

目的分析和探讨糖尿病肾病腹膜透析患者的临床特征和预后。方法入选2009年1月至2011年8月于我中心进行腹膜透析的患者,根据原发病分为糖尿病肾病腹膜透析组和非糖尿病腹膜透析组,收集比较两组患者的基本资料、生化结果和透析相关指标,应用Kaplan-Meier法和Cox回归进行生存分析。结果 460例随访腹膜透析患者中,糖尿病肾病患者64例(13.9%)。糖尿病肾病患者平均年龄高于非糖尿病者,分别为(63±13)岁和(45±16)岁(P<0.001)。糖尿病肾病腹膜透析患者的高敏C反应蛋白(hsCRP)高于非糖尿病腹膜透析患者,而血清白蛋白水平及前白蛋白水平低于非糖尿病腹膜透析患者(P<0.01)。糖尿病肾病腹膜透析患者的甘油三酯和标准蛋白分解率(nPCR)也低于非糖尿病腹膜透析组(P<0.05)。两组患者的血红蛋白、甲状旁腺激素、钙磷水平、胆固醇水平、随访时间、透析充分性和残余肾功能差异无统计学意义。糖尿病肾病和非糖尿病腹膜透析患者第1年累计生存率分别为73.3%和90.7%(P<0.05),第2年分别为61.8%和82.5%(P<0.05)。糖尿病肾病腹膜透析患者的平均生存时间低于非糖尿病腹膜透析患者,分别为24.6月和30.1月(P<0.05)。糖尿病肾病腹膜透析患者死亡风险为非糖尿病腹膜透析患者的2.449倍。在多因素Cox回归分析中年龄和血清白蛋白是糖尿病肾病腹膜透析患者死亡的危险因素。结论糖尿病肾病腹膜透析患者透析开始时的年龄大,易发生营养不良和微炎症状态。年龄和营养不良是影响腹膜透析患者生存的危险因素。糖尿病肾病腹膜透析患者生存率明显低于非糖尿病患者。

A comparison of clinical characteristics and survival between diabetic nephropathy patients and non-diabetic nephropathy patients undergoing peritoneal dialysis

Objective To investigate clinical characteristics and survival of diabetic patients with end-stage renal disease on peritoneal dialysis(PD).Methods The clinical data were collected from the patients who initiated PD in our PD Center from Jan,2009 through Aug,2011.The patients were divided into diabetic group and non-diabetic group,the survival of patients and risk factors of death were analyzed and compared between the two groups by using Kaplan-Meier and Cox regression analysis.Results There were 460 PD patients included in this study,64(13.9%) of them were diabetic and 396(86.1%) were non-diabetic.Compared with non-diabetic PD patients,the PD patients with diabetes were older((63±13) yr.vs(45±16) yr.,P<0.001),while had higher level of high sensitive C reaction protein(hsCRP),lower levels of serum albumin and pre-albumin,as well as lower levels of triglyceride and nPCR.There was no statistical difference in serum concentrations of hemoglobin,parathyroid hormone,cholesterol,and Kt/V and residual renal function between the two groups.The survival rates of PD patients with diabetics versus non-diabetics were 73.3% versus 90.7% at 1 year,and 61.8% vs 82.5%(P<0.05)at 2 years.Mean survival time of diabetic PD patients(24.6 months) was significantly inferior to non-diabetic PD patients(30.1 months)(P<0.05).The relative risk of mortality in diabetic PD patients was 2.449 times of that in non-diabetic patients.Multivariate Cox regression analysis,indicated that serum albumin level and patient age were significant risk factors for mortality.Conclusion Diabetic patients tended to be elderly,malnutrition and microinflammation at the beginning of PD.The survival of diabetic PD patients is inferior to non-diabetic PD patients on CAPD.Age and albumin level were risk factors for mortality in PD patients.