长透析龄腹膜透析患者退出原因特征分析及管理策略

The Analysis of Drop-out Reasons and Management in Long-term Peritoneal Dialysis Patients

目的:分析长透析龄(≥60.0透析月)腹膜透析(腹透)患者退出腹透的临床特征,探讨长透析龄腹透患者的随访管理策略。方法:纳入2017年01月~2017年12月本中心随访的腹透患者。收集患者的人口学、退出状况等资料。分析患者退出原因的特点,为制定管理策略提供依据。结果:研究纳入1069例腹透患者,平均年龄(45.0±14.1)岁,男609例(占57.0%),糖尿病患者166例(占15.5%),心血管病(CVD)病史者140例(占13.1%)。中位透析时间46.7(22.2~78.8)月。长透析龄患者411例(占38.4%)。共有195例(18.2%)患者退出随访:非长透析龄组患者111例,退出原因依次为移植(45.9%)、转血透(27.0%)和死亡(22.5%);长透析龄组84例,退出原因与非长透析龄组患者相反,依次为死亡(48.8%)、转血透(26.2%)和移植(16.7%),两组差异具有统计学意义(P<0.05)。长透析龄组患者的死亡的主要原因为CVD、感染和衰竭/恶液质,转血透的主要原因分别为腹膜炎、透析不充分和超滤衰竭。结论:长透析龄患者占随访人数的38.4%。导致长透析龄患者退出腹透的前三位原因为死亡、转血透和移植。应加强对长透析龄腹透患者的管理。

Objective:This study was to analyze the character of drop-out in long-term(≥60.0 months)peritoneal dialysis(PD)patients,which could provide the basis for taking intensive management in PD follow-up work.Methods:The PD patients who received PD treatment in our center between January 1 and December 31,2017 were recruited.The data was collected including demographics and status of drop-out.The drop-out reasons were analyzed.Results:There were 1069 PD patients were recruited[(mean age 45.0±14.1 years,609 male 57.0%),166 diabetes(15.5%),140 cardiocerebral vascular disease(CVD)history(13.1%)].Median PD duration was 46.7 months(IQR:22.2-78.8).There were 411(38.4%)long-term PD patients.Totally,195(18.2%)patients withdrew PD,including non-long-term PD group111 cases and long-term PD group 84 cases.The main drop-out causes in non-long-term PD group were transplantation(45.9%),switching to hemodialysis(HD)(27.0%),and death(22.5%),wheras the result was reversed in long-tem PD group[death(48.8%),switching to HD(26.2%),and transplantation(16.7%)].CVD,infection and cachexy were the main reasons for death;while peritonitis,inadequate dialysis and ultrafiltration failure were the main reasons for switching to HD in long-term PD patients.Conclusion:The proportion of long-term PD patients was 38.4%.The main drop-out reasons included death,switching to HD and transplantation.It was important to take intensive measures in the follow-up work for the long-term PD patients.