腹膜透析患者不同补铁方式与腹膜透析相关腹膜炎发生的关系

Relationship between different iron supplementation and peritoneal dialysis-related peritonitis

目的比较采用静脉补铁、口服补铁的腹膜透析合并肾性贫血患者腹膜透析相关腹膜炎发生情况,探讨补铁方式与腹膜透析相关腹膜炎的关系。方法2008年1月—2018年12月海军军医大学第一附属医院行持续性不卧床腹膜透析合并肾性贫血患者706例,静脉给予右旋糖酐铁者128例为静脉铁剂组,口服琥珀酸亚铁者578例为口服铁剂组,2组均联合应用重组人促红细胞生成素。采用倾向性评分匹配对2组进行1∶3匹配。比较2组匹配前及匹配后性别比例、年龄、腹膜透析持续时间、原发病、合并症情况。随访终止事件为转换透析方式、肾移植、死亡或失访。记录匹配后2组<45岁、45~65岁、>65岁者腹膜炎发生情况。采用多因素logistic回归分析腹膜透析合并肾性贫血患者发生腹膜透析相关腹膜炎的危险因素。结果(1)倾向性评分匹配前,静脉铁剂组男性比率(46.09%)、慢性肾小球肾炎比率(33.59%)均低于口服铁剂组(53.91%、50.00%)(χ^(2)=5.634,P=0.018;χ^(2)=5.767,P=0.016),年龄[(60.32±13.95)岁]大于口服铁剂组[(52.57±16.16)岁](t=9.367,P<0.001),腹膜透析持续时间[59.7(22.70,91.73)个月]长于口服铁剂组[31.35(14.40,54.23)个月](U=7.112,P<0.001),良性小动脉性肾硬化(37.50%)、糖尿病肾病比率(24.22%)均高于口服铁剂组(21.63%、15.74%)(χ^(2)=14.273,P<0.001;χ^(2)=5.265,P=0.022)。(2)倾向性评分匹配后静脉铁剂组102例,口服铁剂组249例。倾向性评分匹配后,2组年龄、腹膜透析持续时间、原发病及合并症与口服铁剂组比较差异均无统计学意义(P>0.05)。(3)倾向性评分匹配后,静脉铁剂组发生腹膜透析相关腹膜炎123次,发生率为0.291次/患者年。口服铁剂组249例发生腹膜透析相关腹膜炎171次,发生率为0.180次/患者年。2组腹膜透析相关腹膜炎发生率比较差异无统计意义(χ^(2)=1.536,P=0.264)。(4)倾向性评分匹配后,静脉铁剂组<45岁、45~65岁、>65岁者各15、48、39例,分别发生腹膜透析相关腹膜炎13、40、70次,发生率分别为0.086、0.255、0.447次/患者年。口服铁剂组<45岁、45~65岁、>65岁者各51、104、94例,分别发生腹膜透析相关腹膜炎29、58、84次,发生率分别为0.087、0.177、0.259次/患者年。(5)年龄45~65岁(OR=13.011,95%CI:12.352~13.670,P<0.001)、>65岁(OR=54.540,95%CI:53.867~55.212,P<0.001)是腹膜透析合并肾性贫血患者发生腹膜透析相关腹膜炎的危险因素。结论持续性不卧床腹膜透析合并肾性贫血患者静脉或口服补铁方式不影响腹膜透析相关腹膜炎发生率,其发生率随年龄增长而增高。

Objective To compare the incidence of peritoneal dialysis-related peritonitis after intravenous iron supplementation versus oral iron supplementation in patients with renal anemia,and to explore the relationship between iron supplementation and peritoneal dialysis-related peritonitis.Methods A total of 706 patients with renal anemia underwent continuous ambulatory peritoneal dialysis in the First Affiliated Hospital of Naval Medical University from January 2008 to December 2018,among whom 128 patients were given intravenous iron dextran(intravenous iron group)and 578 patients were given oral iron succinate(oral iron group)besides recombinant human erythropoietin in two groups.Propensity score matching was used to perform a 1:3 matching between two groups.The gender ratio,age,duration of peritoneal dialysis,primary diseases and complications were compared between two groups before and after matching.The end events of follow-up included dialysis conversion,renal transplantation,death and loss to follow-up.After matching,the patients in two groups were divided into<45,45-65 and>65 years old groups,and the occurrence of peritonitis was recorded.Multivariate logistic regression was used to analyze the risk factors of peritoneal dialysis-related peritonitis in patients with renal anemia undergoing peritoneal dialysis.Results(1)Before propensity score matching,the proportions of male patients and chronic glomerulonephritis were lower in intravenous iron group(46.09%,33.59%)than those in oral iron group(53.91%,50.00%)(χ^(2)=5.634,P=0.018;χ^(2)=5.767,P=0.016),the patients were older in intravenous iron group[(60.32±13.95)years old]than in oral iron group[(52.57±16.16)years old](t=9.367,P<0.001),the duration of peritoneal dialysis was longer in intravenous iron group[59.7(27.70,91.73)months]than that in oral iron group[31.35(14.40,54.23)months](U=7.112,P<0.001),and the proportions of benign arteriolar nephrosclerosis and diabetic nephropathy were higher in intravenous iron group(37.50%,24.22%)than those in oral iron group(21.63%.15,74%)(χ^(2)=14.273,P<0.001;χ^(2)=5.265,P=0.022).(2)After propensity score matching,there were 102 cases in intravenous iron group and 249 cases in oral iron group,and the age,duration of peritoneal dialysis,primary diseases and complications showed no significant differences between two groups(P>0.05).(3)After propensity score matching,123 episodes of peritonitis occurrecd in intravenous iron group,and the peritonitis rate was 0.291 episodes per patient per year,while 171 episodes of peritonitis occurred in 249 patients in oral iron group,and the peritonitis rate was 0.180 episodes per patient per year.There was no significant difference in the peritonitis rate between two groups(χ^(2)=1.536,P=0.264),(4)After propensity score matching,peritonitis occurred for 13,40 and 70 episodes in 15,48 and 39 patients in<45,45-65 and>65 years old intravenous iron groups,respectively,with the rates of 0.087,0.177 and 0.259 episodes per patient per year;and for51,104 and 94 episodes in 29,58 and 84 patients in<45,45-65 and>65 years old oral iron groups,respectively,with the rates of 0.087,0.177 and 0.259 episodes per patient per year.(5)Age of 45-65 years old(OR=13.011,95%CI:12.352-13.670,P<0.001)and>65 years old(OR=54.540,95%CI:53.867-55.212,P<0.001)were the risk factors of peritonitis in patients with renal anemia undergoing continuous ambulatory peritoneal dialysis.Conclusions Intravenous iron and oral iron supplementation do not affect the incidence of peritoneal dialysis-related peritonitis in patients with renal anemia undergoing continuous ambulatory peritoneal dialysis,and the peritonitis rate increases significantly with the age.