持续非卧床腹膜透析短期内退出的调查分析

Analysis of the early dropout in patients with continuous ambulatory peritoneal dialysis

目的 通过分析影响持续非卧床腹膜透析 (CAPD)患者一年内退出腹膜透析的因素 ,以期为此类易感人群制定合理的一体化治疗方案。方法 调查 2 0 0 0年 4月 1日至 2 0 0 3年 3月 31日在本腹透中心进行CAPD的终末期肾病患者的临床资料 ,包括性别、年龄、透析龄和糖尿病发病情况、退出腹膜透析的时间和原因、死亡病例的死因 ;采用体格损害指数、Charlson指数来评估患者合并症情况。结果 有 139例入选本研究 ,观察期间退出腹膜透析的有 5 0例 (35 .97% ) ,透析后一年内退出的有 4 0例 (占总退出例数 80 % ) ,其中死亡 32例 (2 3.0 2 % )、肾移植 4例、转血液透析 4例 ;在三月内退出腹膜透析的有2 2例 ,其中死亡 2 0例 ;在透析后一年内 32例死亡病例中 ,其中死于心肌梗死 6例 (19% )、充血性心力衰竭 7例 (2 3% )、中风 3例 (9% )、感染 5例 (16 % )、放弃治疗 3例 (9% )、多器官功能衰竭 1例 (3% )、呼吸衰竭 2例 (6 % )、恶性肿瘤 2例 (6 % )及其他不明原因 3例 (9% ) ;logistic回归分析提示Charlson指数、体格损伤指数、性别对CAPD患者一年内死亡退出的影响的相对危险度分别为 1.5 5 4、2 .12 5、2 .82 1,并均具有统计学意义 (P <0 .0 5 )。结论 心血管事件是CAPD患者在透析后一年内死亡的主要原因 。

objective To analyze the reason and risk factors associated with dropout of patients within one year after initiation of continuous ambulatory peritoneal dialysis (CAPD). Methods Between 1st April 2000 and 31st March 2003, all new CAPD patients were recruited. Patient demographic characteristics, duration of dialysis, the prevalence of diabetes, date and cause of dropout, cause of death were recorded. Comorbidity at initiation of dialysis was assessed by Charlson index and physical injury index. Results A total of 139 patients were included in this study, of which 50 (35.97%) cases dropped out. Among the 40 cases who dropped out within one year after initiation of CAPD, 32 cases died (6 died of acute myocardial infarction, 7 died of congestive heart failure, 3 died of stroke, 5 died of infection, 3 died of rejecting treatment, 1 died of multiple system organ failure, 2 died of malignancy, 2 died of respiration failure, 3 died of others), 4 cases received renal transplantation, 4 cases were switched to hemodialysis. The relative risk (RR) of death established by logistic regression analysis for effect of comorbidity assessed by Charlson index and physical injury index, gender on patients dropping out within one year after initiation of CAPD were as follows: Charlson index, RR = 1.554 (P = 0.004); physical injury index, RR = 2.125 (P = 0.037); gender, RR=2.821 (P=0.034). Conclusions Our study suggests that cardiovascular event is the primary cause of death in patients who dropped out within one year after initiation of CAPD, and comorbidity is an important risk factor for the dropout.