射血分数保留性心力衰竭合并终末期肾病不同透析方式下疗效对比

Comparison of therapeutic effects of ESRD with HFpEF under different dialysis methods

目的回顾性观察射血分数保留性心力衰竭(heart failure with preserved ejection fraction,HF⁃pEF)合并终末期肾病(end stage renal disease,ESRD)患者血液透析与腹膜透析两种透析方式在随访终点时透析充分性、电解质、营养状态、心衰再住院次数、NYHA分级改善情况并进行对比。方法收集2010年01月至2019年6月在南方医科大学珠江医院接受HD(n=57)与PD(n=60)患者的临床资料,排除透析时长<3个月的患者,对两组进行比较。结果两组在首次透析前年龄、性别、BMI、MAP、心率、血生化、NT⁃proBNP、NYHA分级、病史比较均无明显差异(P>0.05)。在随访终点时,HD组较CAPD组在NYHA分级、心衰再住院次数下降(P<0.05)。两组患者在随访终点时血清肌酐、尿素氮、尿酸水平均有明显下降(P<0.01),但HD组血肌酐、尿素氮值比PD组下降更加明显(P<0.01)。HD组较PD组在随访终点时血白蛋白、血钾水平上升(P<0.05)。两组平均动脉压、血脂等的变化无统计学意义(P>0.05)。结论本研究中,随访终点时HD组在改善心功能分级、透析充分性、电解质紊乱、营养状态方面要优于PD组。

Objective Retrospective observation of hemodialysis(HD)and peritoneal dialysis(PD)in patients ESRD with HFpEF compared in dialysis adequacy,electrolytes,nutritional status,the number of re⁃hospi⁃talization due to heart failure and the improvement of New York Heart Association grade at the end of follow⁃up.Methods Clinical data of patients treated with HD and PD in Zhujiang Hospital of Southern Medical University from January 2010 to June 2019 were collected.The patients with dialysis duration less than 3 months were excluded.The dialysis adequacy,electrolytes,nutritional status,times of re⁃hospitalization due to heart failure and the im⁃provement of New York Heart Association grade were compared between the two groups before the first dialysis and at the end point of follow⁃up.Results There was no significant difference in age,sex,BMI,MAP,heart rate,blood biochemistry and kidney function,NT⁃proBNP,New York Heart association grade and medication between two groups(P>0.05).At the end of follow⁃up,the NYHA grade and the number of rehospitalization due to heart failure in the HD group were significantly lower than those in the CAPD group(P<0.05).The levels of serum creatinine,urea nitrogen and uric acid were decreased significantly in both groups(P<0.01),but the levels of serum creatinine and urea nitrogen in HD group were much significantly lower than those in PD group(P<0.01).The levels of serum albumin and serum potassium in HD group were significantly higher than those in PD group at the end of follow⁃up.There was no significant difference in mean arterial pressure and blood lipid between the two groups(P>0.05).Conclusion In this study group,We conclud that the improvement of cardiac function,dialysis adequacy,electrolyte disturbance and nutritional status in the HD group are superior to those in the PD group at the end of follow⁃up.