合并心血管疾病的终末期肾病患者不同透析方式的死亡风险

Mortality differences by dialysis modality among dialysis patients with cardiovascular diseases

目的：探讨合并心血管疾病（CVD）的终末期肾病患者不同透析方式的死亡风险差异。方法：选取2009年5月至2014年5月来自广州军区广州总医院及广州市第一人民医院共591例透析患者。采集基线人口统计学资料、合并症及实验室指标等，采用Cox比例风险模型分析不同透析方式的患者的死亡风险差异。结果：共纳入终末期肾病患者591例，其中腹膜透析（PD）组有285例，血液透析（HD）组有306例。合并CVD的患者有123例，无CVD的患者468例。血液透析患者的平均年龄为（57．83±16．15）岁，腹透患者的平均年龄为（46．67±14．85）岁。多因素研究分析，心血管疾病（HR=3．270，95％CI：1．573．6．798，P=0．002）、脑卒中（HR=2．479，95％C1：1．034—5．945，P=0．042）、Kt／V（HR=2．433，95％C1：1．610—3．676，P〈0．001）是血液透析组的死亡危险因素。年龄（HR=1．063，95％CI：1．032～1．096，P〈0．001）、脑卒中（HR=3．980，95％CI：1．781—8．891，P=0．001）及低血红蛋白（HR=0．966，95％CI：0．945—0．987，P=0．002）是腹膜透析组的死亡危险因素。无论选择何种透析方式，合并CVD的透析患者的死亡率均高于无CVD的透析患者。而无论有无合并CVD，PD组的生存率均高于HD组。差异具有统计学意义。结论：合并CVD的透析患者死亡率高于无CVD的透析患者。合并CVD的患者选择腹膜透析较血液透析具有更高的生存率。

Objective To investigate the mortality differences by dialysis modality among dialysis patients with cardiovascular diseases（CVD）. Methods 591 ESRD patients from General Hospital of Guangzhou Military Command of PLA and Guangzhou First People＇s Hospital were enrolled in this study. The demography data, complications, laboratory data were collected. The survival rate and risks factors of mortality were assessed by Cox regression analysis. Results 285 patients underwent hemodialysis （HD）, and the remainder patients underwent peritoneal dialysis （PD）. While 123 patients with CVD, and 468 without CVD. Cox regressive analysis showed that CVD（HR = 3.270, 95%CI： 1.573 - 6.798, P = 0.002）, stoke（HR = 2.479, 95%CI： 1.034 - 5.945, P = 0.042 and Kt/V（HR = 2.433, 95%CI： 1.610 - 3.676, P 〈 0.001） were the important risk factors of all-cause mortality in HD group. Age （HR = 1.063, 95%CI： 1.032- 1.096, P 〈 0.001）, stroke （HR= 3.980, 95%CI： 1.781 - 8.891, P = 0.001） and lower Hemoglobin （HR = 0.966, 95%CI： 0.945 -0.987, P = 0.002） were the important risk factors of all-cause mortality in PD group. Our study revealed that patients with CVD resulted in better survival rate compared with those without CVD. Meanwhile, our study also found the decreased survival rates in CVD and non-CVD patients received HD, but not PD. Conclusion Dialysis patients with CVD resulted in better survival rate than patients without CVD. PD is considered as a better choice for ESRD patients along with decreased mortality rate.