腹膜透析开始时残余肾功能对预后影响的研究

Effect of residual renal function on patient prognosis at the initiation of peritoneal dialysis

目的探讨慢性肾脏病(CKD)5期患者在开始腹膜透析时残余肾功能对预后的影响。方法回顾性分析大连医科大学附属第一医院肾内科2006-12-01—2009-04-30行规律性腹膜透析患者118例。按肾小球滤过率(eGFR)(≤5mL/min,>5mL/min)及预后(死亡或存活)分别分为两组。比较开始透析时肾小球滤过率(eGFR)、血红蛋白、血清白蛋白、存活时间(月)、死亡情况。结果 eGFR≤5mL/min组62例,平均存活时间(15.86±1.34)个月,eGFR>5mL/min组56例,平均存活时间(24.05±1.18)个月,差异有统计学意义。eGFR≤5mL/min组患者白蛋白和血红蛋白明显低于eGFR>5mL/min组。Lo-gistic分析显示eGFR≤5mL/min,白蛋白低于30g/L,血红蛋白低于100g/L,年龄大于70岁是死亡的危险因素。结论开始透析时有较高残余肾功能的患者有较长的存活期,残余肾功能、白蛋白、血红蛋白和年龄是死亡的危险因素。

Objective To determine the effects of residual renal function on the mortality of patients at the beginning of peritoneal dialysis. Methods We retrospectively studied the clinical outcomes in patients （ n = 118） who underwent peritoneal dialysis at our hospital between Dec 1 2006 and Apr 30 2009. All patients were followed up for more than 3 months, eGFR, serum albumin, urea, creatinine, calcium, phosphorus and hemoglobin at the beginning of peritoneal dialysis and the survival time were recorded. They were grouped according to eGFR（≤5 mL/ min, 〉 5 mL/min） and survival or death. Results Mean survival period of 62 patients in eGFR ≤5 mlJmin group was shorter than that of 56 patients in eGFR 〉5 mL/min group[ （.15.86 ± 1.34） months vs （24. 05 ± 1.18） months ,P 〈 0. 05 ]. Death group had lower eGFR, serum ALB, calcium, and higher serum phosphorus than survival group. Conclusion The survival period is longer for the patients who have higher eGFR at the initiation of peritoneal dialysis.