初始腹膜透析转血液透析患者长期预后的分析

Long-term prognosis of peritoneal dialysis patients switching to hemodialysis

目的了解初始腹膜透析患者转血液透析的原因,观察其长期预后,并分析其死亡原因。方法选取1990年1月1日—2010年12月31日期间在上海交通大学医学院附属仁济医院行维持性血液透析的患者,排除在开始血液透析前有肾移植史和≥2次透析模式转变的患者,最终479例患者纳入研究,其中行单纯血液透析412例(单纯血透组),初始行腹膜透析后转血液透析67例(腹透转血透组)。分析腹透转血透组患者转血液透析的原因;比较两组患者开始透析的年龄、透析龄、性别构成、原发病构成,透析开始后1、5、10年的存活率,以及死亡原因构成。结果腹透转血透组患者转血液透析的原因依次为腹膜炎46例(68.7%),胸膜漏10例(14.9%),超滤衰竭8例(11.9%),其他3例(4.5%)。腹透转血透组患者开始透析的年龄显著小于单纯血透组(P<0.05),女性患者比例显著高于单纯血透组(P<0.01),透析龄显著长于单纯血透组(P<0.05);两组间原发病构成和透析开始后1、5、10年的存活率的差异均无统计学意义(P值均>0.05)。在随访期间,腹透转血透组患者死亡31例,死亡原因依次为脑卒中8例(25.8%)、恶液质7例(22.6%)、感染6例(19.4%)、猝死4例(12.9%)、其他3例(9.7%)、心血管事件2例(6.5%)、原因不明1例(3.2%);单纯血透组患者死亡177例,死亡原因分别为脑卒中57例(32.2%)、感染34例(19.2%)、恶液质31例(17.5%)、猝死21例(11.9%)、心血管事件17例(9.6%)、原因不明9例(5.1%)、其他8例(4.5%)。两组间死亡原因构成的差异均无统计学意义(P值均>0.05)。结论初始腹膜透析患者转血液透析的主要原因为腹膜炎、胸膜漏和超滤衰竭,其长期预后并不劣于单纯血液透析患者,但该结论有待进一步大样本研究予以证实。

Objective To determine the causes of peritoneal dialysis switching to hemodialysis as well as the long-term prognosis and reasons of deaths. Methods The patients undergoing maintenance hemodialysis in our hospital from January 1st, 1990 to December 31st, 2010 were enrolled in this study. Those with kidney transplantations before hemodialysis or with two and more changes of dialysis modes were excluded. Finally, 479 patients were included. There were 412 patients with hemodialysis （group A） and 67 with hemodialysis switching from peritoneal dialysis （group B）. The causes why peritoneal dialysis patients switched to hemodialysis were analyzed. The age, dialysis period, sex, primary diseases, survivals of 1, 5 and 10 years after dialysis as well as reasons of deaths were compared between the two groups. Results The main cause of peritoneal dialysis patients switching to hemodialysis was peritonitis （46 cases, 68. 7%）, followed by pleural fistula （10 cases, 14.9%）, ultrafiltration failure （8 cases, 11.9% ） and ethers （3 cases, 4.5% ）. There were significantly younger age （P〈0.05） at initial dialysis, more females （P〈0.01） and longer dialysis period （P〈0.05） in group B than group A. There were no significant differences in primary diseases or survivals after dialysis between groups （allP〉0.05）. During follow-up, 31 patients died in group B and the causes of death were stroke （8 cases, 25.8% ）, followed by cachexia （7 cases, 22.6 % ）, infection （6 cases, 19.4 % ）, sudden death （4 cases, 12.9 % ）, others （3 cases, 9.7%）, cardiovascular events （2 cases, 6.5%）and unknown （1 case, 3.2%）. In group A, 177 patients died and their causes of deaths were stroke （57 cases, 32.2 % ）, infection （34 cases, 19.2 % ）, cachexia （31 cases, 17.5 % ）, sudden death （21 cases, 11.9 %）, cardiovascular events （ 17 cases, 9.6 % ）, unknown （9 cases, 5.1%）and others （8 cases, 4. 5%）. No significant differences in the causes of death were found between the two groups （all P〉O.05）. Conclusion Primary causes of peritoneal dialysis patients switching to hemodialysis are peritonitis, pleural leakage and ultrafiltratJon failure. Their long-term prognosis is not worse than that of simple hemodialysis patients.