维持性肾替代治疗患者腹膜透析转血液透析的因素探讨

Causes of end stage renal disease patients transfering from peritonealdialysis to hemodialysis

目的:分析终末期肾病患者腹膜透析转血液透析的原因,并探讨其相关因素。方法:回顾分析176例行腹膜透析治疗的终末期肾病患者的临床资料,将退出腹膜透析转向血液透析的患者设为转换组,继续行维持性非卧床腹膜透析的患者作为对照组,并行对比分析。结果:176例腹膜透析患者中有23例(13.1%)改为血液透析治疗,其中7例为腹膜透析相关性腹膜炎,6例为透析不充分,5例为腹透管功能障碍,3例为超滤衰竭(ultrafiltration failure,UFF),其他2例。与对照组相比,转换组患者年龄较大,文化程度低,原发病为糖尿病肾病较多,开始透析时肌酐清除率(creatinine clearance rate,CCr)更低,营养不良及贫血程度较严重(P<0.05)。结论:腹膜透析相关性腹膜炎仍然是腹膜透析技术失败的主要原因,早期肾脏替代治疗,规范患者操作程序,改善患者贫血及营养状况有助于提高腹膜透析患者的技术存活率。

Objective： To analyze the reasons of patients transferring from peritoneal dialysis （PD） to hemodialysis and explore the risk factors. Methods： The clinic data of 176 patients who received peritoneal dialysis were analyzed retrospectively. The patients were divided into two groups and analyzed comparatively. Results： Among the 176 patients, 23 cases （13.1% ） transferred from PD to hemodialysis. The reasons for the transfer were PD associated peritonitis （ 7 cases, 30.4% ）, insufficient dialysis （ 6 cases, 26.1% ）, mechanical complications （ 5 cases, 21.7% ） , ultrafihration failure （3 cases, 13.0% ） and some other reasons （2 cases, 8.7% ）. The switched cases had older age, lower culture, more diabetie patients, lower ereatinine clearance rate , more serious malnutrition and anemia. Conclusion： The PD associated peritonitis is the top reason for patients to transfer from PD to hemodialysis. Earlier stage renal replacement therapy, more standardized operational process and better nutrional state can improve the PD technical survival rate.