腹膜透析患者的长期生存率及影响因素:西南地区单中心研究

Long-term survival influencing and risk factors in peritoneal dialysis patients:a single center study in Southwest China

单中心回顾性队列研究,纳入2001年1月1日至2013年12月31日四川省人民医院新置管开始腹膜透析的患者,收集临床及实验室资料,分析腹膜透析患者的长期生存率、技术存活率及相关影响因素。随访截至2021年12月31日或发生终点事件(患者死亡或停止腹膜透析治疗)。使用Kaplan-Meier生存曲线估算腹膜透析患者的生存率和技术生存率。使用Cox比例风险回归模型分析腹膜透析患者死亡及技术失败的危险因素。纳入373例患者,年龄(52.1±15.8)岁,男性199例(53.4%)。随访期间,患者死亡154例(41.3%),转血液透析72例(19.3%),接受肾移植40例(10.7%)。Kaplan-Meier生存分析结果显示,患者1、3、5、7和10年的总体生存率分别为92.2%、76.6%、66.0%、52.4%和38.6%,技术存活率分别为93.5%、84.8%、74.2%、62.8%和44.5%。多因素Cox回归模型分析结果显示,年龄(HR=1.055,95%CI 1.039~1.073,P<0.001)、有血液透析史(HR=2.212,95%CI 1.514~3.231,P<0.001)、多次发生腹膜炎(HR=2.141,95%CI 1.194~3.837,P=0.011)、Charlson合并症指数(HR=1.525,95%CI 1.305~1.783,P<0.001)及基线血清白蛋白(HR=0.951,95%CI 0.925~0.978,P<0.001)是患者生存的独立影响因素。多次发生腹膜炎(HR=2.327,95%CI 1.274~4.250,P=0.006)及Charlson合并症指数(HR=1.244,95%CI 1.035~1.496,P=0.020)是患者技术存活的独立影响因素。腹膜透析患者具有较好的早期生存率和技术存活率,但长期结局需要进一步改善。腹膜炎是腹膜透析患者长期生存率低和技术存活率低的主要危险因素。

Patients who initiated peritoneal dialysis(PD)in Sichuan Provincial People's Hospital from January 1,2001 to December 31,2013 were enrolled in the single center and retrospective study.Clinical and laboratory data were collected to analyze the long-term survival rates,technique survival rates and associated influencing factors.Patients were followed up until December 31,2021 or endpoints occurred(death or stopping PD treatment).Kaplan-Meier survival curves were used to estimate survival rates and technique survival rates.Cox proportional hazards regression model was used to analyze the risk factors of death and technique failure in PD patients.A total of 373 patients were enrolled in the study,with age of(52.1±15.8)years old and 199(53.4%)males. During the follow-up, 154 (41.3%) patients died, 72 (19.3%) patients transferred tohemodialysis, and 40 (10.7%) patients received kidney transplant. Kaplan-Meier survival curvesrevealed that overall survival rates of PD patients at 1, 3, 5, 7, and 10 years were 92.2%, 76.6%,66.0%, 52.4% and 38.6%, respectively. Technique survival rates were 93.5%, 84.8%, 74.2%, 62.8%and 44.5% at 1, 3, 5, 7, and 10 years, respectively. Multivariate Cox regression model results showedthat age (HR=1.055, 95% CI 1.039-1.073, P<0.001), transfer from hemodialysis (HR=2.212, 95% CI1.514-3.231, P<0.001), episodes of peritonitis (HR=2.141, 95% CI 1.194-3.837, P=0.011), Charlsoncomorbidity index (HR=1.525, 95% CI 1.305-1.783, P<0.001), and baseline albumin (HR=0.951,95% CI 0.925-0.978, P<0.001) were independent influencing factors of survival in PD patients.Episodes of peritonitis (HR=2.327, 95% CI 1.274-4.250, P=0.006) and Charlson comorbidity index(HR=1.244, 95% CI 1.035-1.496, P=0.020) were independent influencing factors of techniquesurvival in PD patients. PD patients have good early survival rates and technical survival rates, butlong-term outcomes need to be further improved. Peritonitis is a major risk factor for low long-termsurvival rates and technical survival rates in PD patients.