终末期糖尿病肾病血液透析和腹膜透析预后的比较研究

A comparative study of the prognosis in end-stage diabetic kidney disease patients treated with hemodialysis and those treated with peritoneal dialysis

目的回顾性观察血液透析(hemodialysis,HD)和连续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)2种不同方式对终末期糖尿病肾病患者临床预后及生存率的影响。方法收集2007年1月～2012年5月在上海交通大学医学院附属新华医院接受HD(n=73)和CAPD(n=42)治疗的终末期糖尿病肾病患者的临床资料,排除透析时间<3月者,比较2组患者首次透析前及观察期终止时的各项临床指标、并发症、生存率、死因等情况。结果 HD与CAPD2组在首次透析年龄、血肌酐、尿素氮、肾小球滤过率、血红蛋白、血白蛋白、血尿酸等基线特征上无显著差异(P>0.05);在观察期终止时血红蛋白、血钙、血磷、全段甲状旁腺激素(iPTH)水平均无显著性差异(P>0.05),而HD组血浆白蛋白水平显著高于CAPD组(P<0.05),HD组血浆白蛋白水平较首次透析前显著性升高(P<0.05);HD组发生心功能不全、出血事件、脑梗死的比例较CAPD组显著升高,差异具有显著性(P<0.05);二者感染患病率相似,差异无显著性(P>0.05);HD与CAPD2组死亡率无显著性差异,主要死亡原因为心力衰竭、重度感染、出血和脑血管病,死因构成上2组比较无显著性意义(P>0.05);CAPD组1、3、5年生存率均显著高于HD组(P<0.05),但首次透析年龄≥65岁的CAPD组1、3、5、7年生存率均显著低于HD组(P<0.05)。结论本研究群体中,年龄<65岁的终末期糖尿病肾病患者CAPD5年内生存率优于HD,而年龄≥65岁的患者宜选择HD方式,其生存率优于CAPD。

Objectives To investigate the clinical outcome and survival rate of diabetic end stage renal disease （ESRD） patients treated with continuous ambulatory peritoneal dialysis （CAPD） or mainte- nance hemodialysis （HD）. Methods We retrospectively studied the clinical data of 115 dialysis patients secondary to diabetic nephropathy （73 on HD, 42 on CAPD） treated in Xinhua Hospital during the period between January 2007 and May 2012. Patients on dialysis for less than 3 months were excluded. Their clinical parameters, complications, survival rate, mortality and its causes were compared between HD and CAPD groups before and after the dialysis. Results There were no significant differences in baseline parameters including age at the beginning of dialysis, serum creatinine, blood urea nitrogen, glomerular filtration rate, hemoglobin, serum albumin, and uric acid before the dialysis between the two groups （P 〉 0.05）. At the end of observation period, hemoglobin, serum calcium, phosphorus and iPTH were indiffer- ent between the two groups （P 〉 0.05）, but serum albumin was significantly higher in HD group than in CAPD group （P 〈 0.05）. In HD group, serum albumin was significantly higher at the end of dialysis than that before dialysis （P 〈 0.05）. The incidences of cardiac insufficiency, bleeding, and cerebral infarction were higher in HD patients than in CAPD patients （P 〈 0.05）, but the incidence of infection was similar between the two groups （P 〉 0.05）. There were no significant difference in mortality rate between the two groups （P〉0.05）. The main causes of death in the two groups were heart failure, severe infections, bleeding and cerebrovascular disease, and the causes of death were statistically indifferent between the two groups （P 〉 0.05）. The 1-, 3-, and 5-year survival rates were higher in CAPD group than in HD group （P 〈 0.05）. However, the 1-, 3-, 5-, and 7-year survival rates were lower in the subgroup of the patients ≥ 65 years old in CAPD group than in HD group. Conclusion In our patients with diabetic ESRD, the 5-year survival rate was higher in the patients 〈65 years old in CAPD group than in HD group. However, HD was preferable to CAPD to have a higher survival rate in the patients 〉65 years old.