腹膜透析患者透析时机的选择对预后的影响

The impact of initiation timing of dialysis on the outcome in peritoneal dialysis patients

目的探讨腹膜透析患者开始透析的时机对预后的影响及腹透患者死亡的危险因素。方法选取286例行腹膜透析患者,根据患者开始透析时的eGFR值将患者分为3组,A组：eGFR〈5 ml/（min·1.73 m2）71例,B组：eGFR 5~10 ml/（min·1.73 m2）142例,C组：eGFR〉10 ml/（min·1.73 m2）73例,采用Kaplan-meier法比较3组患者生存率,COX回归分析腹透患者死亡的危险因素。结果生存分析结果提示,A组生存率显著低于B组和C组,差异有统计学意义（P〈0.05）,而C组与B组间差异无统计学意义（P〉0.05）。多因素COX回归结果显示,过晚透析、高龄、糖尿病和低白蛋白血症是腹透患者死亡的独立危险因素。结论过晚开始透析或许是腹膜透析患者死亡的一个危险因素,过早透析不能改善其预后。高龄、糖尿病和低白蛋白血症是腹透患者死亡的独立危险因素。

Objective To study the effect of initiation timing of dialysis on clinical outcome in peritoneal dialysis patients and its risk factors. Methods According to the inclusion and exclusion criteria,patients have been recruited in the peritoneal dialysis center of our hospital from January 1,2010 to December 31,2012. The patients were divided into three groups according to the eGFR at the start of dialysis： group A,eGFR5 ml /（min·1.73 m2）,group B,eGFR 5~10 ml /（min·1.73 m2）,group C,eGFR10 ml /（min·1.73 m2）. The survival rates of three groups were compared using the Kaplan-meier analysis,and risk factors for death in dialysis patients were analyzed by COX regression. Results Overall 286 patients were recruited into this study. The survival rate of group A was significantly lower than that of group B,and there was no significant difference between group B and group C. Starting very late to dialysis,older,diabetes mellitus and hypoalbuminemia were the independent risk factors of mortality in peritoneal dialysis patients. Conclusion Too late to dialysis may be a risk factor for death in patients with peritoneal dialysis,but too early to dialysis does not improve the prognosis of patients. In addition,older,diabetes mellitus and hypoalbuminemia were the independent risk factors of mortality in peritoneal dialysis patients.