老年终末期肾病患者不同紧急起始透析方式的预后分析

Prognostic analysis of different urgent-start dialysis methods in elderly patients with end-stage renal disease

目的探讨对于需要紧急起始透析的老年终末期肾病患者来说,腹膜透析是否可替代血液透析作为紧急起始透析的一种选择.方法本研究为回顾性队列研究,以本中心2013年1月1日至2019年6月1日于我院肾病内科首次开始行血液透析或腹膜透析治疗,并于我院定期随访治疗的≥65岁的终末期肾病患者为研究对象,所有患者均在置管5d内启动透析.按照透析方式不同分为紧急起始血液透析组(USHD)和紧急起始腹膜透析组(USPD),随访至2019年12月31日.比较两组患者短期(术后30 d)透析相关并发症及患者生存情况.结果纳入符合紧急起始透析的老年终末期肾病患者89例,其中USPD组为40例,USHD组49例.USHD和USPD组之间感染相关性并发症(0.0%比2.5%)、非感染性并发症(2.0%比2.5%)、需重新置管(0比0)、菌血症发生率(0比0)的差异均无统计学意义(P>0.05).Kaplan-Meier生存曲线显示USHD组和USPD组患者的中位生存时间分别为63.0个月和38.0个月,差异无统计学意义(Log Rank检验,χ^(2)=0.025,P=0.88).Charlson合并症指数(HR:1.205,95%CI:1.026~1.415,P=0.023)、白蛋白水平(HR:0.949,95%CI:0.903~0.997,P=0.037)是影响老年紧急起始透析患者生存预后的独立危险因素.进一步对老年紧急起始透析患者的白蛋白水平、合并症指数进行分层及交互分析,结果显示各个分层中两种透析方式对老年终末期肾病患者生存率的影响差异无统计学意义(P>0.05).结论腹膜透析导管置入术后5d内开始透析治疗安全有效,对于需要紧急起始透析的老年终末期肾病患者,腹膜透析可替代血液透析作为紧急起始透析的一种选择.

Objective To investigate whether peritoneal dialysis can replace hemodialysis as an option for urgent-start dialysis for elderly patients with end-stage renal disease who need emergency initial dialysis.Methods This was a retrospective cohort study,with enrolment of patients 65 years with end-stage renal disease who started hemodialysis or peritoneal dialysis for the first time at the nephrology department of our hospital between January 1,2013 and June 1,2019 and were followed up regularly.All patients started dialysis within 5 days of catheterization.According to different dialysis methods?patients were divided into the urgent-start hemodialysis(USHD)group and the urgent-start peritoneal dialysis(USPD)group,and were followed up until December 31,2019.Short-term(30 days after the procedure)dialysis-related complications and survival were compared between the two groups.Results A total of 89 elderly patients with end-stage renal disease receiving urgent-start dialysis were included,with 40 cases in the USPD group and 49 cases in the USHD group.There was no significant difference in the incidences of infection-related complications(0.0%vs.2.5%),non-infection-related complications(2.0%vs.2.5%)t re-catheterization(0 vs.0)and bacteremia(0 vs.0)between the two groups(P>0.05).The Kaplan-Meier survival curve showed that the median survival times of patients with USHD and with USPD were 63.0 months and 38.0 months respectively,with no statistical significance(Log Rank,χ^(2)=0.025,P=0.88).The Charlson comorbidity index(HR:1.205,95%CI:1.026-1.415,P=0.023)and albumin level(HR:0.949,95%CI:0.903-0.997,P=0.037)were independent risk factors for the survival and prognosis of elderly patients with urgent-start dialysis.Furthermore,we stratified and made an interactive analysis of the albumin level and the comorbidity index of elderly patients with urgent-start dialysis and found that there was no significant difference between the two modes of dialysis in the survival rate of elderly patients with end-stage renal disease(P>0.05).Conclusions It is safe and effective to start dialysis within 5 days after peritoneal dialysis catheterization.For elderly patients with end-stage renal disease,peritoneal dialysis can replace hemodialysis as an option for urgent-start dialysis.