慢性移植肾失功的透析时机及影响因素

背景：移植肾功能丧失后要及时转入透析以继续维持患者生命，并为部分患者的再移植作准备。目前国内有关移植肾功能丧失后透析时机的报道尚不多见。目的：探讨慢性移植肾失功患者开始透析的时机及其影响因素。方法：调查2005年7月至 2012年12月上海长征医院肾移植康复病房收治的肾移植后慢性移植肾失功患者98例，回顾性分析其临床资料，主要包括内生肌酐清除率、血肌酐、尿毒症症状及并发症，比较不同血液透析时机患者间的差别，分析影响透析时机的因素。结果与结论：透析前87%的患者有明显尿毒症症状，78%出现心、脑并发症，31.6%需急诊透析。全部移植肾失功患者进入血液透析时的内生肌酐清除率为（5.94±0.63） mL/min，9例患者内生肌酐清除率〉 10 mL/min，51例患者内生肌酐清除率为5-10 mL/min，38例患者内生肌酐清除率〈 5 mL/min。其中合并丙肝患者进入血液透析治疗时的内生肌酐清除率明显比非丙肝患者高（P 〈 0.05）。结果显示，开始透析的慢性移植肾失功患者有明显尿毒症并发症，多数透析时机较迟，尤其是丙肝患者。健康宣教、医疗保健是影响透析时机的关键因素。

Dialysis time and influencing factor in chronic renal allograft dysfunction patients

BACKGROUND： Patients with chronic renal allograft dysfunction need dialysis to maintain their survivals and even re-transplantation. However, there is little evidence addressing the time for the initiation of dialysis in patients with chronic renal allograft dysfunction. OBJECTIVE： To discuss the timing of beginning dialysis and the factors that might contribute to dialysis in chronic renal allograft dysfunction patients.METHODS： A retrospective study was performed in clinical data of 98 chronic renal allograft dysfunction patients which were recruited from Shanghai Changzheng Hospital from July 2005 to December 2012. The clinical data included creatinine clearance, serum creatinine concentration, symptoms of uremia and comorbidity. Factors that might affect the timing of dialysis were further analyzed.RESULTS AND CONCLUSION： 86.73% of the patients experienced nausea or vomiting before dialysis, 77.55% occurred with cardiac morbidity and/or neuropathy, and 31.63% needed urgent hemodialysis. Among the 98 patients, the mean creatinine clearance at the time for initiation of hemodialysis was （5.94±063） mL/min, the initial mean creatinine clearance was 〉 10 mL/min in 9 patients, 5-10 mL/min in 51 patients, and 〈 5 mL/min in 38 patients. Hepatitis C virus infection patients had higher initial creatinine clearance than non-infected patients（P 〈 0.05）. Experimental findings suggest that, chronic renal allograft dysfunction patients have obvious uremia complications at the beginning of dialysis, the timing for dialysis is late, especially in hepatitis C virus infection patients. Health education and medical care of chronic kidney disease are key factors that affect the timing of dialysis.