腹膜透析溶质高转运患者预后危险因素分析

Risk factors of mortality in patients on maintenance peritoneal dialysis with high peritoneal transport status

目的回顾性分析基础腹膜溶质高转运特性的维持性腹膜透析患者临床资料,分析影响其预后的危险因素。方法选取新置透析导管接受腹膜透析治疗,且基础腹膜溶质转运特性为高转运的患者290例,随访记录患者临床资料,根据截止随访时间患者的生存状态将其分为生存组与死亡组。比较两组患者的临床资料,并分析影响患者预后的危险因素。结果至随访截止日期,生存组患者249例,死亡组患者41例,病死率14.1%。死亡组患者年龄、Charlson合并症指数(CCI指数)、持续非卧床腹膜透析(CAPD)模式治疗比例、随访期营养不良率均高于生存组(均P<0.05),随访期超滤量低于生存组(P<0.05)。多因素Cox回归分析显示高龄(HR=3.368)、CCI指数高(HR=2.478)、CAPD模式治疗(HR=4.336)、随访期营养不良(HR=5.255)、随访期超滤量不足(HR=6.750)均是影响腹膜透析溶质高转运患者预后的独立危险因素(均P<0.05)。结论临床表现不同的腹膜透析溶质高转运患者预后存在差异,关注影响其预后的独立危险因素并采取相应的预防、治疗措施或可降低其死亡风险。

Objective To analyze the risk factors of mortality in patients on maintenance peritoneal dialysis(PD)with highperitoneal transport characteristics.Methods Clinical data of290PD patients with high peritoneal transport status,includingbiochemical findings,dialysis adequacy,peritonitis and nutritional status,were retrospectively analyzed.The Cox regressionmodel was used to analysis the risk factors for death-censored technique failure and mortality.Results Patients were followedup until March30,2016with a mean follow-up time of41.5(3-116)months.Among290patients,41died and50were switchedto hemodialysis with a fatality rate of14.1%.The COX regression model showed that the age(HR=3.368),high CharlsonComorbidity Index(CCI)(HR=2.478),decreased ultrafiltration volume(HR=6.750),malnutrition(HR=5.255),PD model(HR=4.336)were the independent risk factors of mortality in patients with high peritoneal transport status at baseline.Conclusion Theclinical outcome of PD patients with high peritoneal transport status varies.Pay attention to the risk factors of poor prognosis,andtaking appropriate prevention and treatment measures may improve the survival of patients.