腹膜透析患者退出原因分析

Reasons for the dropout of peritoneal dialysis patients

目的探讨本中心腹膜透析患者退出腹膜透析的原因。方法本研究为单中心、回顾性队列研究。选择2005年11月1日至2017年2月28日在南昌大学第一附属医院肾内科腹膜透析中心置管并进行腹膜透析的患者,随访截止日期为2017年5月31日。截至随访日期仍继续腹膜透析患者为对照组,退出腹膜透析患者分为死亡组、转血液透析(简称转血透)组、肾移植组、失访组4个亚组。各亚组分别与对照组进行比较,分析各组临床特点。结果本研究共纳入998例患者,570例(57.11%)为男性,开始腹膜透析年龄为(49.36±14.94)岁,中位透析龄为27.13(12.84,42.29)个月;其中退出患者共517例,退出率达51.80%。退出主要原因为死亡258例(49.90%),其次为转血透166例(32.11%),肾移植66例(12.77%),失访27例(5.22%)。死亡原因首位为心脑血管事件136例(52.71%),其次为感染42例(16.28%),恶质病20例(7.75%),肿瘤5例(1.94%);转血透主要原因为透析不充分76例(45.78%),其次为腹膜炎55例(33.13%),导管功能不良24例(14.46%)。与对照组比较,死亡组患者开始腹膜透析时年龄高,合并高血压、糖尿病及心脑血管疾病比例高(均P<0.05);转血透组男性、合并糖尿病比例高(均P<0.05)。生化指标中死亡组开始透析时血白蛋白、血磷均低于对照组(均P<0.05),转血透组血白蛋白低于对照组(P<0.05)。结论本中心腹膜透析患者退出腹膜透析主要原因为死亡和转血透。死亡主要原因为心脑血管事件,转血透主要原因为透析不充分。

Objective To explore the reasons for withdrawal from peritoneal dialysis (PD) in our hospital. Methods This was a single-center, retrospective cohort study. Patients who started PD in the Department of Nephrology, the First Affiliated Hospital of Nanchang University from November 1st, 2005 to February 28th, 2017, were enrolled, and followed up to May 31, 2017. Patients who continued PD after May 31, 2017 were as the control group. Patients who withdrew from PD were divided into 4 subgroups: death group, hemodialysis group, kidney transplantation group and loss of follow-up group. The clinical characters of 4 subgroups were compared with the control group. Results A total of 998 patients were enrolled with age of (49.36±14.94) when PD started and median dialysis duration of 27.13(12.84, 42.29) months, in whom 570 patients (57.11%) were male. Five hundred and seventeen dropout events were recorded, and the dropout rate was 51.80%. The main reason for withdrawal from PD was death (258 patients, 49.90%), followed by hemodialysis (166 patients, 32.11%), kidney transplantation (66 patients, 12.77%) and loss to follow-up (27 patients, 5.22%). The leading cause of death was cardio-cerebro-vascular diseases (136 cases, 52.71%), followed by infection (42 cases, 16.28%), dyscrasia (20 cases, 7.75%) and tumor (5 cases, 1.94%). The main reason for transfering to hemodialysis was insufficient dialysis (76 cases, 45.78%), followed by peritonitis (55 cases, 33.13%) and catheter dysfunction (24 cases, 14.46%). Compared with those in the control group, in the death group patients were older at PD commencement, and had higher proportions of hypertension, diabetes and cardio-cerebro-vascular diseases (all P<0.05). The proportions of male and diabetes mellitus were higher in the hemodialysis group than those in the control group (both P<0.05). Biochemical indicators showed that serum albumin and blood phosphorus were lower in the death group than those in the control group (both P<0.05);blood albumin was significantly lower in the hemodialysis group than that in the control group (P<0.05). Conclusions The main reasons for withdrawal from PD in our center are death and transfering to hemodialysis. The cardio-cerebro-vascular disease is the leading cause of death, and inadequate dialysis is the main reason for transfering to hemodialysis.