腹膜透析患者退出原因分析

目的 探讨持续性非卧床腹膜透析患者退出腹膜透析的原因及其影响因素,为改善持续性非卧床腹膜透析患者的预后提供依据.方法 分析在我院进行持续性非卧床腹膜透析的终末期肾脏病患者的临床资料,统计退出腹膜透析患者例数并分析其原因.结果 95例入选患者中有39例患者退出腹膜透析,退出率为41.1%,退出原因死亡为56.4%(22/39)、改血液透析为20.5%(8/39)和肾移植为15.4%(6/39).患者死亡的主要原因为心力衰竭(54.5%)和肺部感染(27.3%).死亡组患者高龄、开始透析时的残余肾功能差、营养不良及贫血程度较重;此外死亡组患者原发病为糖尿病比例与对照组比较差异有统计学意义(P<0.05),且使用血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂控制血压与对照组比较差异也有统计学意义(P<0.05).腹膜炎是导致患者改血液透析的主要原因.结论 死亡是持续性非卧床腹膜透析患者退出腹膜透析的主要原因,患者死亡的主要原因为心血管疾病和感染、高龄、糖尿病、残余肾功能差、贫血和营养不良是影响患者生存的危险因素,早期肾脏替代治疗、积极改善贫血和营养状况以及使用血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂可改善持续性非卧床腹膜透析患者的预后.

The cause of dropout in peritoneal dialysis patients

Objective To investigate the cause of dropout in patients with continuous ambulatory peritoneal dialysis (CAPD). Methods Ninety - five CAPD patients were enrolled. Their dropout was reviewed. Results Among the 39 patients who dropped out, 22 cases died, 8 cases switched to hemodialysis, 6 cases received renal transplantation. The major cause of death was heart failure (54.5%) and lung infec-lion (27.3%). The death cases had older age, lower lever residual renal function(RRF), more serious mal-nutrition and anemia (P <0.05). Besides, diabetic patients were more general in the death cases (P <0.05)and fewer patients with hypertension were treated with angiotcnsin - converting enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARB) in death cases (P < 0. 05). Peritonitis was the main cause that CAPD patients switched to hemedialysis. Conclusions Death was the main major carse of dropout in CAPD patients. Cardiovascular diseases and infection were the major causes of death. Older age, diabetic nephrop-athy, lower lever BRF, malnutrition and anemia resulted in poor prognosis in CAPD patients. Earlier renal replacement therapy, better nutritional state and treated with ACEI or ARB wiU improve the prognosis of CAPD patients.