影响腹膜透析患者血红蛋白水平达标的相关因素分析

Analysis of the factors influencing the targeted hemoglobin level in peritoneal dialysis patients

目的分析影响腹膜透析(peritoneal dialysis,PD)患者血红蛋白(hemoglobin,Hb)达标的相关因素。方法分析2003年5月1日至2015年10月31日宁夏医科大学总医院随访1年及以上的PD患者临床资料。按研究结束时Hb水平将患者分为达标组(Hb≥110g/L)和未达标组(Hb<110g/L),根据贫血分级标准将未达标组分为轻度贫血(90g/L≤Hb<110g/L)和中重度贫血组(Hb<90g/L);比较达标组与未达标组及未达标组不同程度贫血患者临床特征,分析影响Hb未达标的相关因素。结果①共纳入267例PD患者,男性59.93%,平均年龄52岁,中位透析龄37(21,61)月。基线Hb(80.16±14.89)g/L,研究结束时Hb达标率为50.30%。②与达标组比较,Hb未达标组患者年龄、肾小球滤过率、基线Hb水平、Kt/V、红细胞生成素使用量低,透析龄、全段甲状旁腺激素(intact parathormone,iPTH)高(t/Z值分别为2.894,4.400,6.833,3.992,1.396,-3.757,2.364;P值分别为0.004,<0.001,<0.001,<0.001,0.041,<0.001,0.019);③轻度贫血组较Hb达标组患者年龄、基线Hb水平、残余肾小球滤过率、Kt/V及红细胞生成素使用量低,透析龄、iPTH高(t/Z值分别为2.021,6.193,2.515,3.729,-2.336,-2.768,-2.312;P值分别为0.044,<0.001,0.013,<0.001,0.019,0.006,0.021);④Logistic回归分析提示女性、年龄轻、透析不充分、低蛋白血症是Hb不达标的独立危险因素(OR值分别为0.416,1.019,0.285,0.942;P值分别为0.021,0.003,<0.001,0.027)。结论女性、年龄轻、透析不充分及低蛋白血症是Hb不达标的独立危险因素。

Objective To investigate the risk factors influencing peritoneal dialysis(PD)patients to reach the target hemoglobin(Hb)level.Methods PD patients treated in the General Hospital of Ningxia Medical University during the period from May 2003 to October 2015 and followed up for more than one year were retrospectively analyzed.Based on the Hb level at the end of follow-up period,they were divided into targeted group(Hb≥110g/L)and non-targeted group(Hb<110g/L);patients in the non-targeted group were further divided into mild anemia subgroup(90g/L≤Hb<110g/L)and moderate or severe anemia subgroup(Hb<90 g/L).The risk factors influencing peritoneal dialysis(PD)patients to reach the target Hb level were obtained through the comparison of clinical characteristics between targeted group and non-targeted group and between the two subgroups.Results①A total of 267 PD patients were enrolled in this study.In this cohort of PD patients,59.93%were males,the mean age was 52 years old,the median PD vintage was 37 months,the mean follow-up period was 37(21,61)months,the baseline mean Hb level was 80.16±14.89g/L,and 50.30%of the patients reached the targeted Hb level.②Patients in non-targeted group had younger age,longer PD vintage,lower rGFR,lower baseline Hb level,higher iPTH level,lower Kt/V and lower erythropoietin dose,as compared with those in the patients in targeted group(t/Z=2.894,-3.757,4.400,6.833,2.364,3.992 and 1.396 respectively;P=0.004,<0.001,<0.001,<0.001,0.019,<0.001 and 0.041 respectively).③Patients in mild anemia subgroup had younger age,longer PD vintage,lower baseline Hb level,rGFR,Kt/V and erythropoietin dose,and higher iPTH as compared with those in the patients in targeted group(t/Z=2.021,-2.768,6.193,2.515,3.729,-2.336 and-2.312 respectively;P=0.044,0.006,<0.001,0.013,<0.001,0.019 and 0.021 respectively);similar results could also be found when the comparisons were made between moderate or severe anemia subgroup and targeted group.④Multivariate logistic regression analysis showed that female(OR=0.416,P=0.021),younger age(OR=1.019,P=0.003),inadequate dialysis(OR=0.285,P<0.001)and hypoalbuminemia(OR=0.942,P=0.027)were the independent risk factors for unable to reach the target Hb level.Conclusions Female,younger age,inadequate dialysis and hypoalbuminemia were the independent risk factors for failure to reach the target Hb level.