自动化腹膜透析在紧急透析中的应用

The application of automated peritoneal dialysis in patients with urgent dialysis indication

目的探讨紧急自动化腹膜透析(automated peritoneal dialysis, APD)治疗的有效性和安全性。方法回顾性收集1996年3月～2016年12月31日在北京协和医院行紧急自动化腹膜透析(紧急APD)的16例患者的临床资料,分别从187例紧急间歇性腹膜透析(intermittent peritoneal dialysis,IPD)患者(紧急IPD)和464例常规开始腹膜透析(peritoneal dialysis,PD)的患者(非紧急PD)中以1:2选择年龄、性别、开始腹膜透析时间与紧急APD组匹配的患者作为对照。比较不同组的治疗效果、短期机械并发症和感染并发症、长期技术生存及患者生存方面的差异。结果与同期32例紧急IPD和32例非紧急PD患者相比,16例紧急APD患者的基线资料仅在置管距腹膜透析开始时间方面短于非紧急PD组(5天比15天,P<0.001)。透析开始1个月后,紧急APD组平均每日超滤量高于紧急IPD组(730ml比125ml,P=0.010),其余临床和生化指标及其较透析前的变化与紧急IPD组,非紧急PD组比较无差异。透析开始3个月后紧急APD组每周尿素清除指数低于非紧急PD组(2.10±0.22比2.70±0.63,P=0.001),而每周肌酐清除率、残余肾小球滤过率和标准蛋白分解率与紧急IPD组、非紧急PD组比较无差异。紧急APD组无腹膜炎生存时间、技术生存及腹膜透析开始180天内导管相关机械及感染并发症与紧急IPD组和非紧急PD组比较无差异。紧急APD组患者6个月、1年及3年生存率分别为85.1%,69.6%和60.9%,多因素校正后与紧急IPD和非紧急PD比较紧急APD不影响患者预后(P=0.804,P=0.173)。结论紧急APD与紧急IPD或非紧急PD比较,无论在透析效果、并发症、技术生存和患者生存方面均无差异,可以作为需要紧急透析的腹膜透析患者的治疗选择。

Objective To investigate the efficiency, complications and long-term prognosis of urgentstart automated peritoneal dialysis(urgent-APD). Methods This retrospective study enrolled 16 urgent-APD patients treated in Peking Union Medical College Hospital from March 1996 to December 31, 2017. In addition, we randomly chose 32 peritoneal dialysis(PD) patients who matched the urgent-start APD patients in age, gender and dialysis time from 187 urgent-start intermittent peritoneal dialysis(urgent-IPD) and 464 conventional-start PD patients. The efficiency, mechanical and infectious complications, technique survival and patient survival were compared between the groups. Results There were no differences in baseline characteristics between the groups except that the period from catheter insertion to PD initiation was shorter in urgentAPD patients than in conventional-start PD patients(5 days vs. 15 days, P<0.001). After PD initiation for one month, the mean daily ultrafiltration volume was greater in urgent-APD patients than in urgent-IPD patients(730 ml vs. 125 ml, P=0.010). After PD initiation for 3 months, weekly Kt/V was lower in urgent-APD patients than in conventional-start PD patients(2.10 ± 0.22 vs. 2.70 ± 0.63, P=0.001), and weekly creatinine clearance rate(Ccr) and residual glomerular filtration rate(r GFR) were comparable between urgent-APD, urgent-IPD and conventional-start PD patients. In the first 180 days after PD initiation, there were no differences in peritonitis-free survival, technique survival, and mechanical and infectious complications between urgent-APD, urgent-IPD and conventional-start PD patients. In urgent-APD patients, the 6-month, one-and 3-year survival rates were 85.1%, 69.6% and 60.9% respectively. Multivariate Cox hazard model showed that urgent-APD was not the independent risk factor for mortality(P=0.804 and 0.173, compared to urgent-IPD and conventional-start PD patients respectively). Conclusions Urgent-start APD has comparable efficiency, incidence of complications, technique survival and patient survival with urgent-start IPD and conventional-start PD. Therefore, urgent-start APD can be used as an alternative in the patients with urgent dialysis indication.