腹膜透析在慢性肾脏病急性加重治疗中的应用

Utilization of peritoneal dialysis in acute kidney failure on chronic kidney disease

目的观察腹膜透析治疗慢性肾脏病急性加重的疗效。方法纳入2013年3月～2016年2月期间在上海交通大学医学院附属仁济医院因发生慢性肾脏病急性加重而行腹膜透析的病例并前瞻性随访2年,观察肾功能恢复、患者生存、腹膜炎等情况。结果共23例患者入选,其中男性14例(60.9%),中位年龄68岁。至随访结束,11例(47.8%)患者肾功能恢复脱离透析、5例(21.7%)死亡、1例(4.3%)失访、6例(26.1%)维持腹膜透析治疗。该群患者的平均腹膜炎发生率为1次/38.9患者每月。相对于其他患者,肾功能恢复患者的基础肾脏病病因不同(χ~2=18.381,P=0.031),基础肾功能水平处于CKD1～3期的比例较高(χ~2=11.967,P=0.001),合并心脑血管疾病(χ~2=11.294,P=0.001)和糖尿病(χ~2=5.977,P=0.014)较少,Charlson合并症指数较低(Z=-2.128,P=0.033),开始透析时血浆B型脑钠肽较低(Z=-2.985,P=0.003)而血肌酐较高(t=2.103,P=0.048),其平均腹膜透析维持时间(5.4±4.3)月(范围10天～13.3月)。结论腹膜透析可作为需要肾脏替代治疗的慢性肾脏病急性加重患者的治疗选择。

Objective To evaluate the effect of peritoneal dialysis(PD) in acute kidney injury on chronic kidney disease(AKI on CKD). Methods Patients undergoing PD due to AKI on CKD in Renji Hospital,School of Medicine, Shanghai Jiao Tong University between March 2013 and February 2016 were enrolled and prospectively followed up for 2 years. Results A total of 23 patients(14 males; median age 68 years)were enrolled. By the end of the study, PD terminated and renal function recovered in 11 patients(47.8%), 5 patients(21.7%) died, follow-up lost in one patient(4.3%), and PD continued in 6 patients(26.1%). Prevalence of peritonitis in this cohort was 1 episode/38.9 patient-months. CKD etiology differed among patients with and without renal recovery(χ^2=18.381, P=0.031). In patients with renal recovery, preexisting CKD at stage 1-3 was more prevalent(χ^2=11.967, P=0.001); cardiovascular disease(χ^2=11.294, P=0.001) and diabetes mellitus(χ^2=5.977, P=0.014) were less prevalent; additionally, they had lower Charlson comorbidity index scores(Z=-2.128, P=0.033), lower plasma BNP(Z=-2.985, P=0.003) and higher serum creatinine(t=2.103, P=0.048) at the beginning of PD; Average PD vintage was 5.4±4.3 months(10 days^13.3 months). Conclusions PD can be used as a renal replacement therapy in AKI on CKD.