江宁地区持续性非卧床腹膜透析患者退出原因的分析及对策

Reasons for withdrawal of patients undergoing continuous ambulatory peritoneal dialysis in Jiangning district and corresponding countermeasures

目的分析南京市江宁地区持续性非卧床腹膜透析（continuous ambulatory peritoneal dialysis，CAPD）患者退出原因及对策。方法回顾性分析2008年1月至2015年5月在南京医科大学附属江宁医院接受腹膜透析置管术进行CAPD135例患者的临床资料，调查其退出时间和退出原因，同时记录腹膜透析置管时的血红蛋白、血白蛋白、血钾、血钙、血磷、血肌酐、尿素氮和估算肾小球滤过率（estimated glomerular filtration rate，eGFR）等指标，资料收集后根据患者的原发病是否为糖尿病肾脏疾病（diabetic kidney disease，DKD）分为DKD组和非DKD组；另外，根据患者的年龄分为青年组（年龄〈40岁）、中年组（年龄41-60岁）和老年组（年龄〉60岁）。根据以上不同的分组进行分析比较。结果本组135例患者，至调查终点维持腹膜透析治疗者83例，退出者52例，退出率为38．52％。男性腹膜透析患者的退出率（30／62，占48．39％）高于女性腹膜透析患者（22／73，占30．14％）。退出腹膜透析的首位和次位原因分别是腹膜透析转血液透析（22／52，占42．38％）及死亡（21／52，占40．38％），而心脑血管系统疾病是导致死亡的最主要的原因（13／21，占61．9％）。DKD组患者开始透析时的血白蛋白、血肌酐、尿素氮、eGFR与非DKD组比较，差异有统计学意义（P〈0．05）。DKD组退出率（22／37，占59．46％）和病死率（12／37，占32．43％）明显高于非DKD的退出率（30／98，占30．61％）和病死率（9／98，占9．18％），差异有统计学意义（均P=0．002）。4例肾移植患者均为青年患者。老年腹膜透析患者退出率高（26／53，占49．06％），而其主要退出原因为死亡（18／53，占33．96％）；结论心脑血管系统疾病是导致腹膜透析患者退出的重要因素；DKD的慢性肾衰竭患者应尽早透析并积极加强透析前一体化治疗；老年腹膜透析患者需要加强社会支持、家庭管理；男性腹膜透析患者需要加强宣教、随访以及透析后再培训。

Objective To analyze reasons for withdrawal of patients undergoing continuous am- bulatory peritoneal dialysis （CAPD） in Jiangning district, Nanjing and corresponding countermeasures. Methods Clinical data of 135 patients undergoing CAPD in our department were retrospectively analyzed to investigate their time and reasons of withdrawal Meanwhile, indexes such as hemoglobin, Alb, serum potassium, serum calcium, serum phosphate, serum creatinine, blood urea nitrogen （BUN） and glomerular filtration rate （GFR） were recorded in peritoneal dialysis catheter insertion. After data were collected, patients were divided into different groups based on if their protopathy was diabetic kidney disease （DKD）, age and gender for comparative analysis. Results Among 135 patients investigated, 83 patients kept on undergoing CAPD until the ending of this survey and 52 patients withdrew, so the withdrawal rate was 38. 52%. Transfer to hemodialysis and fatality were primary and secondary reasons of their withdrawal from peritoneal dialysis. Twenty-two out of 52 patients （42. 38%） withdrew for the former reason and 21 out of 52 patients （40. 38%） withdrew for the latter reason. Cerebrovascular disease was the foremost cause of fatality （13/21, 61.9%）. The withdrawal rate （22/37, 59.46%） and fatality rate （12/37, 32. 43%） of patients whose protopathy was diabetic kidney disease were significantly higher than withdrawal rate （30/98, 30. 61%） and fatality rate （9/98, 9. 18%） of patients without diabetic kidney disease, so the differences were statistically significant （P = 0. 002 in all cases）. Alb, serum creatinine, BUN and GFR in DKD group were compared with those in non-DKD group when began to undertake dialysis. The results suggested that there were statistically significant differences between these two groups （P〈0. 05）. All of four renal transplanta- tion patients were young. Withdrawal rate of old patients undergoing peritoneal dialysis （26/53, 49. 06%） was higher and fatality （18/53, 33.96%） was the main reason of their withdrawal. With- drawal rate of male patients undergoing peritoneal dialysis （30/62, 48. 39%） was higher than females （22/73, 30. 14%）. Conclusions Cerebrovascular disease was an important cause of patients＇ with- drawal from peritoneal dialysis. Patients with chronic renal failure and DKD should undertake dialysis as soon as possible and actively strengthen pre-dialysis integrated treatment. Social support and family management should be strengthened for old patients undergoing peritoneal dialysis. For male patients undergoing peritoneal dialysis, it was necessary to strengthen education, follow-up visit and post-dialysis retraining.