长期腹膜透析患者转归临床分析

Analysis of clinical outcome in long-term peritoneal dialysis patients

目的 研究长期腹透患者临床转归,分析其临床特点。方法 对本院1994年1 月至2003年8月腹透龄超过3年以上的58例腹透患者进行分析。根据其临床转归分为继续腹 透组、转向移植组、转向血透组及死亡组。比较各组间近期营养指标(半年以内血清白蛋白水 平)、近期透析充分性指标(Kt／V、C(?)r)、水清除指标及残肾功能等临床特点。对死亡组同时做回 顾性前后自身对照研究(死亡前半年以内与死亡前1年资料比较)。对继续腹透组回顾性分析比 较1年前资料,并前瞻性追踪随访1年。结果 死亡组总Kt／V显著低于其余3组(P<0．05); 总C(?)r显著低于继续腹透组(P<0．01)。继续腹透组、移植组及血透组3组间总Kt／V、总C(?)r及 血清白蛋白水平差异无统计学意义。血透组水清除指标显著低于继续腹透组及移植组;继续腹 透组水清除指标稍高于死亡组但无显著性差异。死亡组近期总Kt／V显著低于死亡前1年总 Kt／V(P<0．05);近期总C(?)r显著低于死亡前1年总C(?)r(P<0．01)。继续腹透组近期总Kt／V及 总C(?)r与1年前及1年后指标比较差异均无统计学意义,但残肾Kt／V或残肾C(?)r随时间推移 而显著下降(P<0．05)。继续腹透组残肾Kt／V或残肾C(?)r显著高于死亡组及血透组(P< 0．05)。死亡组血清白蛋白水平较其余3组降低但差异无统计学意义。死亡组13例中有7例死 于心脑血管疾病。结论 腹透3年以上患者大部分仍可继续腹透。透析不充分是长期腹透患者 死亡的重要原因。死亡的病因主要为心脑血管疾病。残肾功能可影响长期腹透患者的转归。

Objective To analysis the clinical outcomes in long-term peritoneal dialysis （PD） patients. Methods The data of 58 PD patients survived more than 3 years from January 1994 to August 2003 in our hospital were reviewed. According to their different clinical outcomes, the patients were divided into four groups： continuous PD group, transplant group, hemodialysis （HD） group and death group. The recent nutritional index, such as serum albumin, and the recent dialysis adequacy index, including fluid removal and residual renal function, were evaluated. The “predeath values” of 1/2 year and 1 year prior to death in the death group were compared. 12-month PD indices in continuous PD patients were reviewed retrospectively and the same indices over a 12-month period of time were followed up. Results The recent total Kt/V in death group was significandy lowered than that in the other three groups （P 〈 0.05）. The recent total Ccr in death group was significandy lowered than that in the continuous PD group （P 〈 0.01 ）. There were no significant differences of total Kt/V,total Ccr and serum albumin among PD, HD and transplant groups. The fluid removal in HD group was significandy lowered than that in the continuous PD group or transplant group. The fluid removal in continuous PD group was slightly higher than that of the death group but no statistic difference was found. Compared to one year prior to death, the “predeath values” of total Kt/V and total Ccr in death group were significantly lower （P 〈 0.05, and P 〈 0.0l） respectively. There were no significant differences for recent values of total Kt/V and total Ccr in continuous PD group between one year before and after, but the residual renal Kt/V or residual renal Ccr were significantly reduced with the process of PD （P 〈 0.05）. Compared to the death group and HD group, the residual renal Kt/V or residual renal Ccr in continuous PD group were significantly higher （P 〈 0.05）. There was a decrease trend in serum albumin in death group compared with other three groups, but no significant difference was found. Seven out of 13 in death group died of cardiovascular disease and cerebrovascular diseases. Conclusions Most patients with more than 3 years PD can continue peritoneal dialysis. Dialysis inadequacy leading to cardiovascular and cerebrovascular diseases is an important cause of death for long-term PD patients. Residual renal function plays an important role in long-term PD patients.