影响腹膜透析生存的因素及干预策略

Survival influencing factors and the interventional strategy in patients with peritoneal dialysis

腹膜透析(PD)是终末期肾脏疾病(ESRD)的主要替代治疗方法之一。心血管疾病(CVD)是PD患者死亡的主要原因。慢性肾脏病(CKD)患者存在非传统的、自身疾病特有的心血管危险因素,包括贫血、矿物质代谢紊乱、炎症和氧化应激状态及蛋白质能量消耗,这些都与CKD增加的全因死亡率和心血管疾病死亡率相关。提高PD患者长期生存率的策略包括纠正传统与非传统的心血管危险因素,如血压、血糖、血脂控制,戒烟,纠正贫血、钙磷代谢紊乱,纠正炎症和氧化应激及蛋白质能量消耗,同时必须高度重视PD患者存在的可纠正的影响生存的因素,如残余肾功能、腹膜完整性和PD中心规模。

Peritoneal dialysis （PD） is one of renal replacement therapeutics for patients with end-stage renal disease （ESRD）. PD patients mainly died of cardiovascular disease. Patients with chronic kidney disease （CKD） have risks of cardiovascular disorders, which are non-traditional and related to the disease itself, including anemia, mineral metabolic disturbance, inflammation, oxidative stress, and protein energy wasting. These factors are correlated with the increased mortality of all causes as well as cardiovascular causes. Strategies to improve the long-term survivals of these patients include ： managing of traditional and non-traditional cardiovascular factors such as blood pressure, blood glucose, blood lipid, smoking, anemia and calcium-phosphorus metabolic disturbance;and decreasing inflammation, oxidation stress and protein energy wasting. Meanwhile, high attention should be paid to the survival influencing factors that can be corrected such as residual renal function, peritoneal integrity and size of PD centers.