残肾功能对腹透患者预后影响

Influence of Residual Renal Function on Prognosis of the Patients with Peritoneal Dialysis

目的探讨残肾功能对腹膜透析(peritoneal dialysis,PD)患者长期预后的影响,并建立判断PD预后的方程。方法对389例PD患者行腹膜平衡试验,送检血、24 h尿、24 h腹透液之肌酐(Cr)、尿素氮(BUN)、白蛋白(ALB)、钠、钾、钙、磷,计算腹膜转运功能D/PCr、残肾尿素清除指数(Kt/V)、腹膜Kt/V、每周总Kt/V,残肾肾小球滤过率(GFR)肌酐清除率(CCr)。对存活组及死亡组上述指标进行χ~2检验、t检验,并对相关因素进行Logistic回归分析、COX回归分析及判别分析,建立预测死亡因素的方程。结果 1.女性及高龄PD患者死亡率高,随访及时者生存率高;2.死亡组尿量、残肾Kt/V、尿肌酐清除量、尿BUN清除量、残肾GFR、总CCr均显著低于存活组[(0.34±0.05)L V.S.(0.82±0.04)L,(0.34±0.04)V.S.(0.58±0.03),(24.3±1.8)mg/d V.S.(55.1±2.5)mg/d,(22.5±2.1)mg/d V.S.(61.6±4.0)mg/d,(1.83±0.35)ml/min/1.73m^2V.S.(3.19±0.2)ml/min/1.73m^2,(51.8±22.1)ml/min/1.73 m^2V.S.(62.8±27.1)ml/min/1.73 m^2,P<0.05];3.经Logistic回归分析,性别、年龄、尿量之χ~2分别为21.675、20.846、16.997,P=0.000,OR分别为4.076、1.052、5.465;4.随着每日水份清除量(尿量+超滤量)的增加,生存率逐渐增加(总清除量<0.5 L、0.5~0.99 L、1.0~1.49 L、≥1.5 L者,死亡率分别为43.9%、24.8%、14.4%、5.6%,P<0.05);5、判别方程D=1.302×性别(男=1,女=2)+0.026×年龄(岁)-0.773×血磷(mmol/L)-0.962×尿量(L)-1.534。D>0为死亡。对存活组判别正确率为72.8%,对死亡组判别正确率为79.0%,总的判别正确率为73.9%。结论残肾功能丧失、女性患者、增龄是导致PD患者死亡的重要因素。每日水份清除量尤其是尿量减少,是影响PD患者预后的危险因素。

Objective: To investigate long-term prognostic influence of the residual renal function on peritoneal dialysis(PD) patients, and establish an equation to judge PD patients' prognosis. Methods: 389 patients were performed peritoneal equilibrium test. Blood, 24-hour urine and 24-hour dialysate were collected for the detection of creatinine(Cr), urea nitrogen(BUN), albumin(ALB), sodium, potassium, calcium, phosphorus, and calculation of peritoneal transport function D/PCr, residual renal urea clearance index(Kt/V), peritoneal Kt/V, total weekly Kt/V, residual renal glomerular filtration rates(GFR), creatinine clearance rate(CCr). The above indicators were analyzed by χ~2 test, t test in survival group and death group, and the related factors were analyzed by Logistic regression analysis, COX regression analysis and discriminant analysis, and establish an equation of PD patients' death risk. Results: 1) Female and elderly patients with PD was high mortality and the survival rate was high in these PD patients who were visited timely. 2)Urine volume, residual renal Kt/V, urinary creatinine clearance, urinary BUN clearance, residual kidney GFR, total CCr in died group was significantly lower than that of survival group.[(0.34±0.05)L V.S.(0.82±0.04)L,(0.34±0.04)V.S.(0.58 ±0.03),(24.3 ±1.8)mg/d V.S.(55.1 ±2.5)mg/d,(22.5 ±2.1)mg/d V.S.(61.6 ±4.0)mg/d,(1.83 ±0.35)ml/min/1.73 m^2 V.S.(3.19±0.2)ml/min/1.73 m^2,(51.8±22.1)ml/min/1.73 m^2 V.S.(62.8±27.1)ml/min/1.73 m^2,P<0.05]. 3) Sex, age, urine volume were assessed by means of χ~2 tests and logistic regression analysis(χ~2:21.675,20.846,16.997, P=0.000, OR: 4.076,1.052,5.465). 4) With the daily moisture removal(urine + ultrafiltration)increased, the survival rate increased gradually(total removal <0.5 L, 0.5-0.99 L, 1.0-1.49 L, ≥1.5 L, mortality rates were 43.9%,24.8%,14.4%,5.6%, P<0.05). 5) Discriminant equation: D=1.302×sex(male =1,female = 2) +0.026 ×age(years)-0.773×serum phosphorus(mmol/L)-0.962×urine volume(L)-1.534.(D>0: death).The accuracy rate of judging PD patients' prognosis to survival group and died group was 72.8% and 79.0% respectively, and the average was 73.9%. Conclusion: Loss of residual renal function, females, senior patients are the important factors which lead to death. Daily water clearance, especially urinary volume, is a risk factor for the prognosis of patients with PD.