不同透析龄腹膜透析患者的临床特征分析

Clinical characteristics of long-term survivors and short-term survivors on peritoneal dialysis

目的通过长期与短期腹膜透析患者的对比,找寻影响腹膜透析透析龄的临床特征,从而有利于腹膜透析患者的管理。方法选取2006-01-01—2011-12-31长期在浙江大学医学院附属第一医院肾脏病中心诊断为CKD 5期,进行腹膜透析治疗且能够规律性随访时间1年以上的维持性腹膜透析患者,透析时间为4年以上且仍在透析的定义为长期透析;透析时间小于4年定义为短期透析。接受肾脏移植者,腹膜透析时间小于1年但目前仍在随访的患者不包括在内。符合长期透析标准的有50例(A组),由于死亡退出透析的有55例(B组),转血液透析退出的有90例(C组),回顾性分析对比3组患者的临床特征(包括一般情况、生化指标、透析充分性及残肾功能等)。结果平均随访时间A组为(58.33±10.03)个月;B组为(27.15±9.35)个月;C组为(41.65±12.80)个月。A组年龄[(53.06±16.77)岁]与C组年龄[(54.19±16.71)岁]明显较B组[(62.59±14.79)岁]年轻(P<0.01);A组患糖尿病较B组少[8%(4/50)对23.6(13/55),P<0.05];开始透析时血清白蛋白A组[(38.74±4.65)g/L]比B组[(36.15±4.85)g/L]和C组[(35.23±5.27)g/L]高(P<0.01);C组血糖比A组和B组低(P<0.05),B组C-反应蛋白(CRP)较A组和C组高(P<0.01和P<0.05);A组标准化蛋白氮呈现率(nPNA)较B组高(P<0.05),各组间血脂、血红蛋白、全段甲状旁腺激素(iPTH)和钙磷指标差异无统计学意义。开始透析1个月后A组残肾Kt/V、总Ccr、残肾Ccr、尿量均较B组和C组高(P<0.05),超滤量A组较B组和C组少(P<0.05和P<0.01),脉压差A组和C组较B组少(P<0.05),各组间腹膜转运功能、血糖升高发生率差异均无统计学意义。结论与短期透析患者相比,长期腹膜透析患者具有相对年轻、合并糖尿病发生率较少、开始透析时营养状态较好、炎症水平较低(以CRP为指标)、残余肾功能较好、超滤量较少、舒张压低及脉压差较小的特点。

Objective To evaluate the characteristics of patients on long-term and short-term peritoneal dialysis （PD）. Methods Patients who were treated with PD since 2006 to 2011 and on PD for at least one year in our Department of kid-ney disease were included in this study. According to dialysis duration, patients were divided into tree groups. Group A （long-term） was defined as patients survived on PD for more than 4 years. Group B （short-term）was defined as patients who died and Group C （short-term）was defined as switched to hemodialysis within 4 years. Demography, biochemical indexes, di-alysis adequacy, residual renal function were compared between those groups. Results There were 50 patients in group A, 55 patients in group B and 90 patients in group C. Mean followed-up period of group A,group B and group C was （58.33 ± 10.03 ） months, （27. 15 ± 9.35） months and （41.65 ± 12. 80） months, respectively. Younger （ group A [ 53.06 ± 16. 77 ] yrs and group C [54. 19 ± 16. 71 ] yrs vs group B [62. 59 ± 14. 79] yrs,P 〈 0. 01 ） ,fewer episodes of diabetic comorbidity （ group A 4/50 vs group B 13/55, P 〈 0. 05 ） were found in group A. Compared to group B and group C, the level of serum albumin at the beginning of PD was much higher in group A （group A[ 38.74 ± 4. 65 ] g/L vs group B [ 36. 15 ±4. 85 ] g/L and vs group C [ 35.23 ± 5.27 ] g/L,P 〈 0. 01 ）. Compared to group A and group B, the levels of blood sugar in group C is lower. The levels of CRP in group B is higher than in group A and group C（P 〈0. 01 and P 〈 0. 05）. The levels of nPNA in group A is higher than in group B（P 〈 0. 05 ）. The levels of TC, TG, hemoglobin, calcium, phosphate and iPTH were not significantly different between three groups. Renal Kt/V, renal Ccr and urinary volume at the beginning of dialysis were much higher in group A（ P 〈 0. 05 ）. Uhrafiltration volume and pulse pressure difference was less in group A （P 〈 0. 05 ）. Peritonitis morbidity, peritoneal membrane transport,increased blood sugar morbidity were not significantly different between three groups. Conclnsion In comparison to short-term survivors,long-term PD patients are characterized by being younger, less diabetic disease, higher level of serum albumin and hemoglobin, higher volume of urine ,lower level of CRP, better re-sidual renal function , less ultrafihraion and lower pulse pressure difference.