腹膜透析患者第一年死亡的危险因素分析

Risk factors of the first year mortality in patients with peritoneal dialysis

目的:分析腹膜透析(PD)患者透析第一年死亡的相关危险因素,并探讨其干预措施。方法:收集南京医科大学第一附属医院PD中心2003年1月至2014年3月248例PD患者的临床资料,分析18例在透析第一年内死亡的患者的危险因素。结果:患者一年内死亡的原因分别为肺部感染7例(38.89%),心血管事件5例(27.78%),全身衰竭1例(5.56%),脑血管事件1例(5.56%),消化道出血1例(5.56%),肿瘤1例(5.56%),感染性休克1例(5.56%),多脏器功能衰竭1例(5.56%)。一年内死亡组与存活组资料比较分析,死亡组年龄高于对照组,且更多合并糖尿病、肺部感染、心血管疾病及使用免疫抑制剂(P<0.01)。将两组患者的辅助检查结果进行对比,死亡组患者估算的肾小球滤过率(e GFR)及C反应蛋白(CRP)高于对照组(P<0.05),血清白蛋白(Alb)(P<0.01)、血清肌酐(P<0.01)及血钾(P<0.05)均低于对照组。结论:高龄、糖尿病、肺部感染、心血管疾病、使用免疫抑制剂、低钾血症均是PD患者在透析第一年死亡的危险因素,低Alb和高CRP是其独立危险因素。积极控制感染、纠正低钾血症、改善营养及微炎症状态有利于改善PD患者的生存。

Objective：To investigate the risk factors of the first year mortality in patients with peritoneal dialysis （PD）, and to explore the preventative ways. Methodology：The clinical data of two hundred forty eight PD patients in PD center from 2003 to 2014 were retrospectively reviewed. Among them, 18 patients died in one year after PD, and their risk factors were investigated. Results ：The main cause of mortality was pulmonary infection （38.9%） and cardivascular event （27.8%）. Compared with the living patients in one year, the patients died in one year were senior, and had more complications of diabetes, pulmonary infection and cardiovascular disease and more immunosuppressant utilization. Between the two groups, there were no significant differences in urine volume, HB, TC, HDL, LDL, TG, BUN, UA, Ca, P, iPTH, Weekly Kt,/V, Weekly Cer, cardiothoracic ratio and ejection fraction. The eGFR and CRP were higher than control group, while the serum Alb,Scr,potassium（ K＋） were lower. According to logistic regression analysis, low serum Alb and high CRP were independent risk factors of first year mortality in PD patients. Conclusion： Advanced age, diabetes, pulmonary infection, cardiovascular disease, immunosupppressant utilization, hypokalemia should be risk factors in patients with peritoneal dialysis died in the first year. The Low-Alb and high CRP were the independent risk factors. To control infection and ameliorate hypokalemia, nutrition and micro-inflammatory state may be help to improve survival in patients undergoing peritoneal dialysis.