罗沙司他治疗初始腹膜透析合并肾性贫血的生存率及预后影响因素研究

Research of postoperative survival rate and prognostic factors of roxadustat for initial peritoneal dialysis patients with renal anemia

目的探讨罗沙司他对腹膜透析(peritoneal dialysis,PD)合并肾性贫血患者预后的影响。方法分析2019年4月至2022年4月在北部战区总医院行PD置管术并规律随访的肾性贫血患者的临床数据,根据是否使用罗沙司他将患者分为罗沙司他组和非罗沙司他组(对照组),采用Kaplan-Meier方法计算生存率,绘制生存曲线,并利用多因素Cox回归比例风险模型分析影响生存率的危险因素。结果共纳入PD合并肾性贫血患者114例,其中,罗沙司他组共63例,对照组共51例。基线资料中,罗沙司他组患者的透析前血肌酐水平更高、二氧化碳结合力水平更低。中位随访时间为17.5(9,27)个月,至随访终点共38例患者发生死亡。罗沙司他组的生存时间是(30.739±1.565)月(95%CI 27.673~33.806),对照组的生存时间是(24.148±1.955)月(95%CI 20.316~27.980)。Kaplan-Meier生存曲线分析显示,罗沙司他组的3年生存率(62.4%)明显高于对照组(27.3%)(Log-rankχ^(2)=6.593,P=0.01)。校正混杂因素后,多因素Cox回归分析结果显示,BMI(HR=1.187,95%CI 1.066~1.322,P=0.002)是初始PD合并肾性贫血患者全因死亡的独立危险因素,使用罗沙司他(HR=0.453,95%CI 0.217~0.945,P=0.035)是初始PD合并肾性贫血患者全因死亡的独立保护因素。结论罗沙司他可有效地降低初始PD合并肾性贫血患者的死亡风险,改善长期预后。

Objective To investigate the effect of roxadustat treatment on the prognosis of peritoneal dialysis(PD)patients with renal anemia.Methods The clinical data of patients with renal anemia who underwent PD catheterization in the General Hospital of Northern Theater Command and were regularly followed up from April 2019 to April 2022 were collected and the patients were divided into roxadustat group and non-roxadustat group(control group).Overall survival(OS)analysis was performed by Kaplan-Meier method to draw survival curve.Multivariable Cox proportional hazards regression models were established to analyze the risk factors affecting the survival rate.Results A total of 114 PD patients with renal anemia were included.There were 63 patients in the roxadustat group and 51 patients in the control group.In the baseline data,higher serum creatinine level and lower CO_(2)combining power levels were observed in the roxadustat group.The median follow-up time was 17.5(9,27)months and a total of 38 patients died at the follow-up endpoint.The mean survival time in the roxadustat group was(30.739±1.565)months(95%CI 27.673-33.806),which was(24.148±1.955)months(95%CI 20.316-27.980)in the control group.Kaplan-Meier survival analysis showed that the 3-year survival rate in the roxadustat group was 62.4%,which was significantly higher than that(27.3%)in the control group(Log-rankχ^(2)=6.593,P=0.01).The multivariate Cox regression analysis showed that BMI(HR=1.187,95%CI 1.066-1.322,P=0.002)was an independent risk factor of all-cause mortality in initial PD patients with renal anemia and use of roxadustat(HR=0.453,95%CI 0.217-0.945,P=0.035)was an independent protective factor after adjusting for other variables.Conclusion Roxadustat can effectively reduce the risk of all-cause mortality and improve long-term prognosis in initial PD patients with renal anemia.