紧急起始腹膜透析患者初始估计肾小球滤过率与全因死亡的关系

Correlation between initial estimated glomerular filtration rate and all-cause mortality in patients with urgent-start peritoneal dialysis

目的探讨紧急起始腹膜透析(USPD)的终末期肾脏病(ESRD)患者初始估计肾小球滤过率(eGFR)与全因死亡的关系。方法回顾性分析济宁医学院附属医院2013年1月至2023年6月380例行USPD的ESRD患者的临床资料。根据初始eGFR中位数6.25 ml/(min·1.73 m^(2))将患者分为低eGFR组[<6.25 ml/(min·1.73 m^(2))]和高eGFR组[≥6.25 ml/(min·1.73 m^(2))],每组190例。比较两组患者的基线资料和USPD治疗前48 h血液学指标。患者随访直至出现死亡或截至2023年6月30日,记录全因死亡情况。绘制Kaplan-Meier生存曲线评估两组患者累积生存率。采用多因素Cox回归分析影响USPD的ESRD患者全因死亡的独立危险因素,并进行亚组(年龄、性别和糖尿病)分析。结果患者中位随访时间40.7(21.7,59.0)个月,112例患者死亡,总病死率为29.5%(112/380)。高eGFR组血钾、血磷、尿素氮、尿酸、甲状旁腺素和透析龄明显低于低eGFR组[(4.1±0.7)mmol/L比(4.5±0.8)mmol/L、(1.6±0.4)mmol/L比(1.9±0.6)mmol/L、(21.8±7.2)mmol/L比(29.7±11.0)mmol/L、(359.8±99.4)μmol/L比(429.4±116.9)μmol/L、242.2(151.5,398.3)ng/L比281.7(189.1,487.2)ng/L和36.1(18.8,54.0)个月比43.7(28.8,68.2)个月],糖尿病率、血红蛋白、血小板计数、血氯、空腹血糖和病死率明显高于低eGFR组[20.0%(38/190)比11.6%(22/190)、(100.6±18.2)g/L比(96.1±20.0)g/L、(207.7±72.6)×10^(9)/L比(192.4±65.6)×10^(9)/L、(100.6±4.1)mmol/L比(99.4±4.7)mmol/L、(5.9±2.3)mmol/L比(5.5±1.9)mmol/L和34.2%(65/190)比24.7%(47/190)],差异有统计学意义(P<0.01或<0.05)。Kaplan-Meier生存曲线分析结果显示,高eGFR组全因病死率明显高于低eGFR组,差异有统计学意义(log-rank χ^(2)=6.64,P<0.01)。在校正性别、年龄及混杂因素后,多因素Cox回归分析结果显示,eGFR升高、红细胞平均体积升高和空腹血糖升高是影响USPD的ESRD患者全因死亡的独立危险因素(HR=1.14、1.04和1.15,95%CI 1.04~1.26、1.01~1.08和1.03~1.29,P<0.01或<0.05),女性是影响USPD的ESRD患者全因死亡的独立保护因素(HR=0.59,95%CI 0.38~0.92,P<0.05)。亚组分析结果显示,eGFR对USPD的ESRD患者死亡效应一致。结论ESRD患者USPD较高的初始eGFR与全因死亡风险升高相关。

ObjectiveTo explore the correlation between the initial estimated glomerular filtration rate(eGFR)and all-cause mortality in end-stage renal disease(ESRD)patients undergoing urgent-start peritoneal dialysis(USPD).MethodsThe clinical data of 380 ESRD patients undergoing USPD from January 2013 to June 2023 in Affiliated Hospital of Jining Medical University were retrospective analyzed.According to the median initial eGFR of 6.25 ml/(min·1.73 m^(2)),the patients were divided into low eGFR group with eGFR<6.25 ml/(min·1.73 m^(2))and high eGFR group with eGFR≥6.25 ml/(min·1.73 m^(2)),with 190 patients in each group.The baseline characteristics and hematological indexes within 48 h before USPD were compared between the two groups.The patients were followed up until death or until June 30,2023,and all-cause mortality was recorded.The Kaplan-Meier survival curve was used to evaluate the accumulated survival rate.Multivariate Cox regression analyses were used to identify the independent risk factors for all-cause mortality in ESRD patients undergoing USPD,with subgroup analyses based on age,gender and diabetes.ResultsThe median follow-up time was 40.7(21.7,59.0)months,112 patients died,with a total mortality rate of 29.5%(112/380).The blood potassium,blood phosphorus,urea nitrogen,uric acid,parathyroid hormone and dialysis age in high eGFR group were significantly lower than those in low eGFR group:(4.1±0.7)mmol/L vs.(4.5±0.8)mmol/L,(1.6±0.4)mmol/L vs.(1.9±0.6)mmol/L,(21.8±7.2)mmol/L vs.(29.7±11.0)mmol/L,(359.8±99.4)μmol/L vs.(429.4±116.9)μmol/L,242.2(151.5,398.3)ng/L vs.281.7(189.1,487.2)ng/L and 36.1(18.8,54.0)months vs.43.7(28.8,68.2)months,the diabetes rate,hemoglobin,platelet count,blood chloride,fasting blood glucose and mortality rate were significantly higher than those in low eGFR group:20.0%(38/190)vs.11.6%(22/190),(100.6±18.2)g/L vs.(96.1±20.0)g/L,(207.7±72.6)×10^(9)/L vs.(192.4±65.6)×10^(9)/L,(100.6±4.1)mmol/L vs.(99.4±4.7)mmol/L,(5.9±2.3)mmol/L vs.(5.5±1.9)mmol/L and 34.2%(65/190)vs.24.7%(47/190),and there were statistical differences(P<0.01 or<0.05).Kaplan-Meier survival curve analysis result showed that the all-cause mortality rate in high eGFR group was significantly higher than that in low eGFR group,and there was statistical difference(log-rank χ^(2)=6.64,P<0.01).After adjusting for gender,age and confounding factors,multivariate Cox regression analysis result showed that elevated eGFR,increased mean corpuscular volume and elevated fasting blood glucose were independent risk factors for all-cause mortality in ESRD patients undergoing USPD(HR=1.14,1.04 and 1.15;95% CI 1.04 to 1.26,1.01 to 1.08 and 1.03 to 1.29;P<0.01 or<0.05),while female was an independent protective factor(HR=0.59,95% CI 0.38 to 0.92,P<0.05).Subgroup analysis result showed a consistent effect of eGFR on mortality in ESRD patients undergoing USPD.ConclusionsHigher initial eGFR in ESRD patients undergoing USPD is associated with an increased risk of all-cause mortality.