维持性腹膜透析患者远期预后的影响因素分析

Analysis in influencing factors of long-term prognosis in patients with maintenance peritoneal dialysis

目的分析维持性腹膜透析(PD)患者远期预后的影响因素。方法回顾性分析2006年1月—2015年8月南京鼓楼医院收治的209例PD患者的临床资料,计算生存率及技术生存率,分析影响预后的危险因素。11例PD患者治疗5年内行肾移植,根据透析龄将其余患者分为长期PD组110例(透析龄≥5年)和短期PD组88例(透析龄<5年),分析透析龄的影响因素。结果209例PD患者1、3、5、8、10年累积生存率依次为97.5%、87.7%、72.0%、54.9%、37.0%,累积技术生存率依次为94.7%、83.8%、73.2%、52.7%、44.3%。COX多因素回归分析显示,置管时年龄大、PD前尿量少、自费医疗、非原发性肾小球肾炎、心血管疾病是PD患者死亡的独立危险因素(P<0.05)。置管时年龄大、自费医疗、腹膜炎是技术失败的独立危险因素(P<0.05)。Logistic回归分析显示,置管时年龄、PD前尿量、随访依从性是影响透析龄的独立危险因素(P<0.05)。结论年龄、随访依从性、PD前尿量是透析龄的独立危险因素。积极预防和控制感染、加强随访管理、保护残余肾功能有助于提高患者生存质量,延长透析时间。

Objective To analyze the influencing factors of long-term prognosis in patients with maintenance peritoneal dialysis(PD).Methods The clinical materials of 209 PD patients treated in Nanjing Drum Tower Hospital from January 2006 to August 2015 were analyzed retrospectively,the survival rate and technical survival rate were calculated,and the risk factors influencing prognosis were analyzed.Kidney transplantation was performed in 11 PD patients within 5 years of treatment.According to the dialysis age of the rest patients,110 patients were enrolled in long-term PD group(dialysis age≥5 years)and 88 patients in short-term PD group(dialysis age<5 years),and the influencing factors of dialysis age were analyzed.Results The 1-,3-,5-,8-and 10-year cumulative survival rates of 209 PD patients were 97.5%,87.7%,72.0%,54.9%and 7.0%respectively,and the cumulative technical survival rates were 94.7%,83.8%,73.2%,52.7%and 44.3%respectively.COX multivariate regression analysis showed that the older age during catheterization,less urine volume before PD,self-paid medical treatment,non-primary glomerulonephritis and cardiovascular diseases were the independent risk factors of death in PD patients(P<0.05).Older age during catheterization,self-paid medical treatment and peritonitis were the independent risk factors of technical failure(P<0.05).Logistic regression analysis showed that age during catheterization,urine volume before PD and compliance of follow-up were the independent risk factors of dialysis age(P<0.05).Conclusion Age,compliance of follow-up and urine volume before PD are independent risk factors of dialysis age.It is helpful to improve the quality of life and prolong dialysis time by actively preventing and controlling infection,strengthening follow-up management and protecting the residual renal function.