腹膜透析患者转血液透析原因及预后分析

Causes and prognosis of patients transferring from peritoneal dialysis to hemodialysis

目的分析腹膜透析患者转血液透析的原因,并探讨影响其预后的因素。方法回顾性分析上海长征医院1999年至2008年39例腹膜透析患者转血液透析的原因,并分析在我院行血液透析的23例患者的预后。结果共有39例腹膜透析患者转血液透析,腹膜透析治疗平均时间(14.4±16.3)月。转血液透析的原因为:透析不充分(30.8%)、技术失败(28.2%)、腹膜透析相关感染(25.6%)、失超滤(10.3%)。在我院行血液透析的23例患者中有12例死亡,11例维持性血液透析治疗。死亡原因主要为心脑血管事件和感染,糖尿病患者平均存活时间明显低于慢性肾炎患者。结论腹膜透析患者转血液透析的主要原因是透析不充分、技术失败和腹膜透析相关感染。原发病类型可能影响转血液透析后患者存活时间,糖尿病肾病患者预后较慢性肾炎患者差。

Objective To analyze the causes and prognosis of patients transferring from peritoneal dialysis to hemodialysis. Methods We retrospectively investigated the causes of transferring from peritoneal dialysis to hemodialysis in 39 patients between 1999 and 2008, and analyzed the prognosis of 23 patients transferred in our hospital. Results In the 39 peritoneal dialysis patients transferred from peritoneal dialysis to hemodialysis, the average peritoneal dialysis time was 14.4±16.3 months, and the reasons for the transfer were dialysis insufficiency （30.8%）, mechanical complications （28.2%）, peritoneal dialysis related infection （25.6%） and ultrafiltration failure （10.3%）. Twenty-three patients were transferred to hemodialysis in our hospital, of which 12 patients died and hemodialysis continued in 11 patients. The major causes of death were cardiocerebrovascular events and infection. Diabetic patients had worse prognosis than patients with glomerulonepthritis. Conclusion The main causes of transferring to hemodialysis were dialysis insufficiency, mechanical complications and peritoneal dialysis related infection. Primary disease leading to renal failure affects the prognosis of patients transferred from peritoneal dialysis to hemodialysis. Patients with diabetic nephropathy have worse prognosis than patients with glomerulonepthritis.