多囊肾病患者行连续性不卧床腹膜透析及血液透析的疗效比较

Comparative study of continuous ambulatory peritoneal dialysis and hemodialysis on polycystic kidney disease patients

目的对比进入终末期肾病（ESRD）的多囊肾病（PKD）患者行连续性不卧床腹膜透析（CAPD）及血液透析（HD）治疗的临床疗效。方法回顾性分析2001年1月至2007年12月期间在我科行透析治疗3个月以上的PKD患者，共29例患者入选，分为CAPD组（10例，34．5％）和HD组（19例，65．5％），选择10例年龄及性别与CAPD组匹配非PKD的CAPD患者作为对照组。记录患者一般资料、透析初始资料、并发症、生存时间、退出透析或死亡等结局。采用Kaplan—Meier法，Log—Rank检验进行生存分析。结果CAPD组1年、3年及5年存活率分别为90％、75％及25％；HD组为94．4％、67．6％及48．3％；对照组为83．3％、44．4％及22．2％，3组患者存活率差异无统计学意义（P〉0．05）。CAPD组与对照组Kt／V[（2．09±0．97）／周比（1．93±0．59）／周】、Ccr[（58．5±9．1）L·周-1（1．73m2）-1比（55．0±9．5）L·周-1·（1．73m2）-1、腹膜炎的发生率（0．62次／病人年比0．30次／病人年）、首次腹膜炎时间f（23．5±4．0）个月比（20．0±15．8）个月1、腹透管出口感染次数（0次比1次）、发生疝的例数（1例比0例）、腹透液渗漏的发生次数（0次比0次）差异均无统计学意义（均P〉0．05）。HD组2例发生脑出血（10．5％），皆死亡；10例（52．6％）发生囊肿m血，其中5例因反复囊肿出血行手术治疗；2例因出血严重行单侧肾脏切除。CAPD组无脑出血发生，仅1例（10％）发生囊肿出血，该囊肿出血患者经保守治疗后好转。HD组出血并发症高于CAPD组（P〈0．05）且较严重。结论PKD患者与非PKD患者行CAPD治疗其预后及并发症的发生比例类似。PKD患者行CAPD治疗与HD治疗的预后同样较好，且行CAPD时出血并发症的风险较少。除非透析前存在疝或患者不耐受，PKD肾衰竭患者既可选择HD也可选择CAPD作为初始的‘肾脏替代治疗方式，PKD不是CAPD治疗的禁忌证。

Objective To compare the efficacy of continuous ambulatory peritoneal dialysis （CAPD） and hemodialysis （HD） on polyeystic kidney disease （PKD） patients with end-stage renal disease （ESRD）. Methods Retrospective analysis was made on 29 patients with PKD who carried out dialysis therapy for over 3 months in our department from January 2001 to December 2007. They were divided into the CAPD group （10 cases, 34.5%） and HD group （19 cases, 65.5%）. Ten cases of non-PKD CAPD patients were randomly selected as the control, who matched the CAPD group in terms of age and gender. The patient information was recorded, such as general data, initial dialysis data, complications, survival time, quit of dialysis or death, etc. Kaplan-Meier method and Log-rank test were adopted to analyze the survival rate. Results The survival rates of 1-, 3- and 5-year for the CAPD group were 90%, 75% and 25% respectively, while for the HD group were 94.4%, 67.6%, and 48.3%, and for the control were 83.3%, 44.4% and 22.2% respectively, with no significant differences among 3 groups （P〉0.05）. Kt/V[（ 2.09±0.97 ）/W vs （1.93±0.59）/W] and Ccr [（58.5±9.1 ） L·W-1·（1.73 m2）-1 vs （55.0±9.5） L·W-1 ·（1.73 m2）-1] of the first appraisal of the sufficiency of peritoneal dialysis for the CAPD group and the control were quite similar. The ineidence of peritonitis for the CAPD group （0.62 times/patient year） was similar to that for the control （0.30 times/patient year）（P〉0.05）. The duration of the first peritonitis[（23.5±4.0） months vs （20.0±15.8） months] and the catheter exit-site inflection （0 time vs 1 time） for two groups were similar as well （P〉0.05）. One patient had hernia in CAPD group and no patient in eontrol group had hernia. The incidence of peritoneal dialysate leakage was similar between these two groups. In the HD group, two patients （10.5%） had cerebral hemorrhage resulting in death, and 10 patients （52.6%） had cystic hemorrhage, 5 out of whom underwent operation due to repeated cystic hemorrhage and 2 cases received unilateral nephrcctomy because of severe hemorrhage. No patient in CAPD group had cerebral hemorrhage but 1 patient （10%） had cystic hemorrhage and recovered alter conservative treatment. The henmrrbage complication incidence of CAPD group was significantly lower than that of HD group （P〈O.05）. Conclusions The prognosis and complication incidence in PKD and non-PKD patients treated with CAPD are similar. The prognosis of PKD patients treated with CAPD or HD is also similar, and the risk of hemorrhage complications of PKD patients treated with CAPD may be decreased compared with those treated with HD. PKD patients can choose HD or PD as the initial therapy of ESRD unless existence of hernia or intolerance. PKD is not the contraindication of PD.