射血分数保留的心力衰竭合并终末期肾病不同透析方式的死亡率比较

Comparison of Mortality Rates Under Different Dialysis Methods in Patients with Heart Failure with Preserved Ejection Fraction Combined with End-stage Renal Disease

目的回顾性比较射血分数保留的心力衰竭(HFpEF)合并终末期肾病(ESRD)患者行血液透析(HD)或腹膜透析(PD)治疗后并发症及死亡率情况。方法收集2010年1月-2019年6月首次在我院接受透析的心衰患者117例。根据透析方法将患者分为PD组(n=60)和HD组(n=57)。PD组采用腹膜透析,HD组采用血液透析,比较两组患者首次透析前血生化指标、透析后主要并发症、死因以及死亡率。结果两组患者首次透析前血生化指标对比,差异无统计学意义(P>0.05);透析后主要并发症中,HD组透析管阻塞率高于PD组(17.54%vs 5.00%),PD组感染率高于HD组(51.67%vs 15.79%),差异均有统计学意义(P<0.05);PD组死亡率高于HD组(15.00%vs 7.02%),差异有统计学意义(P<0.05);死因中,心脏性疾病占总死亡率的46.15%;PD组重症感染占该组死亡人数的44.44%;PD组重症感染死亡率高于HD组(6.67%vs 0),差异有统计学意义(P<0.05)。结论对于射血分数保留射血分数保留的衰竭心力衰竭合并终末期肾病患者的治疗,血液透析在降低患者死亡率、感染率方面均优于腹膜透析。

Objective To retrospectively compare the complications and mortality of patients with heart failure with preserved ejection fraction(HFpEF)combined with end-stage renal disease(ESRD)after hemodialysis(HD)or peritoneal dialysis(PD).Methods A total of 117 patients with heart failure who received dialysis for the first time in the Affiliated Hospital of Southern Medical University from January 2010 to June 2019 were collected.According to dialysis methods,patients were divided into PD group(n=60)and HD group(n=57).PD group was treated with peritoneal dialysis,the duration of dialysis was 6-78 months,the median was 23.5 months;HD group was treated with hemodialysis,the duration of dialysis was6-102 months,the median was 19 months.The blood biochemical indexes before the first dialysis,main complications after dialysis,causes of death and mortality were compared between the two groups.Results There was no significant difference in blood biochemical indexes between the two groups before the first dialysis(P>0.05).Among the major complications after dialysis,the obstruction rate of dialysis tube in HD group was higher than that in PD group(17.54%vs 5.00%),and the infection rate in PD group was higher than that in HD group(51.67%vs 15.79%),the differences were statistically significant(P<0.05).The mortality of PD group was higher than that of HD group(15.00%vs 7.02%),the difference was statistically significant(P<0.05).Among the causes of death,heart disease accounted for 46.15%of the total mortality;severe infection accounted for 44.44%of the deaths in PD group.The mortality of severe infection in PD group was higher than that in HD group(6.67%vs 0),and the difference was statistically significant(P<0.05).Conclusion For the treatment of patients with heart failure with preserved ejection fraction combined with end-stage renal disease,hemodialysis is better than peritoneal dialysis in reducing mortality and infection rate.