腹膜透析病人退出原因分析

Analysis of the reasons for withdrawal of patients with peritoneal dialysis

目的探讨腹膜透析病人的转归,分析腹膜透析病人死亡的危险因素。方法选择2008年1月1日至2019年12月31日在南京医科大学附属江宁医院行规律腹膜透析的病人共230例,分析其人口统计学资料、文化程度、临床资料、转归以及转归原因等。结果共纳入230名腹膜透析病人,其中男性98例(42.6%),开始腹膜透析时年龄为(56±14.8)岁,中位透析龄为28.7(0.2,130.2)个月。至随访终点,共有112例病人退出腹膜透析,退出率为48.7%。退出的首要原因是转血液透析(53例,47.3%),其次是死亡(51例,45.5%),5例(4.5%)病人行肾移植手术,3例(2.7%)病人失访。腹膜透析病人转血液透析的首要原因是腹膜透析相关性腹膜炎24例(45.3%),其次是透析不充分10例(18.9%)。死亡的主要原因为心脑血管意外14例(27.5%),其次是感染10例(19.6%),肿瘤5例(9.8%),其他原因7例(13.7%),15例死亡原因不详(29.4%)。Cox多因素回归模型显示开始腹膜透析时年龄大(HR=1.068,P=0.001)、低白蛋白水平(HR=0.938,P=0.018)、低血红蛋白水平(HR=0.973,P=0.001)、合并糖尿病(HR=2.773,P=0.003)是腹膜透析病人死亡的独立危险因素。结论该中心的腹膜透析退出率为48.7%,退出的主要原因是转血液透析,其次是死亡。转血液透析的主要原因是腹膜透析相关性腹膜炎和透析不充分,死亡的主要原因是心脑血管意外。开始腹膜透析时年龄大、低白蛋白水平、低血红蛋白水平、合并糖尿病是腹膜透析病人死亡的独立危险因素。

Objective To explore the outcomes of peritoneal dialysis(PD)patients and analyze the risk factors for death.Methods A total of 230 patients who underwent regular PD in the Affiliated Jiangning Hospital of Nanjing Medical University from January 1,2008 to December 31,2019 were selected and their demographic data,education level,clinical data,outcomes and causes were ana⁃lyzed.Results A total of 230 PD patients were enrolled,including 98 males(42.6%),the age at the start of peritoneal dialysis was 56±14.8 years,and the median dialysis age was 28.7(0.2,130.2)months.By the end of follow-up,a total of 112 patients withdrew from peritoneal dialysis,with a withdrawal rate of 48.7%.The primary reason for withdrawal was conversion to hemodialysis(53 patients,47.3%),followed by death(51 patients,45.5%),kidney transplantation(5 patients,4.5%)and loss to follow-up(3 patients,2.7%).The primary reason for PD patients to switch to hemodialysis was peritoneal dialysis-related peritonitis(24 patients,45.3%),followed by in⁃sufficient dialysis(10 patients,18.9%).The main cause of death was cardiovascular and cerebrovascular accidents in 14 cases(27.5%),followed by infections in 10 cases(19.6%),tumors in 5 cases(9.8%),other causes in 7 cases(13.7%),and unknown causes of death in 15 cases(29.4%).The Cox multivariate regression model showed that older age(HR=1.068,P=0.001),low albumin level(HR=0.938,P=0.018),low hemoglobin level(HR=0.973,P=0.001)and diabetes mellitus(HR=2.773,P=0.003)were independent risk factors for death in PD patients.Conclusions The PD withdrawal rate in the center was 48.7%,and the main reason for withdrawal was hemodialysis,followed by death.The main reasons for switching to hemodialysis were PD-related peritonitis and insufficient dialysis,and the main cause of death was cardiovascular and cerebrovascular accidents.Older age,low albumin level,low hemoglobin level and comorbidity with diabetes were independent risk factors for death in PD patients at the beginning of PD.