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浙江大学学报（医学版）
浙江大学学报（医学版）  2016, Vol. 45 Issue (2): 195-200    DOI: 10.3785/j.issn.1008-9292.2016.03.13
原著     
临时血液透析对维持性腹膜透析患者生存预后的影响
边薇1, 官继超2, 谢锡绍3, 童金1, 张晓辉3, 寿张飞3
1. 浙江省诸暨市人民医院肾内科, 浙江 绍兴 311800;
2. 浙江省绍兴市人民医院肾内科, 浙江 绍兴 312000;
3. 浙江大学医学院附属第一医院肾脏病中心, 浙江 杭州 310003
Effects of interim hemodialysis on survival and clinical outcomes in patients with maintenance peritoneal dialysis
BIAN Wei1, GUAN Jichao2, XIE Xishao3, TONG Jin1, ZHANG Xiaohui3, SHOU Zhangfei3
1. Department of Nephrology, Zhuji People's Hospital of Zhejiang Province,Zhuji 311800, China;
2. Department of Nephrology, Shaoxing People's Hospital of Zhejiang Province,Shaoxing 312000, China;
3. Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
全文: PDF(1010 KB)  
摘要: 

目的: 探讨临时血液透析对维持性腹膜透析患者生存预后的影响及相关因素。方法: 回顾性分析2010年1月1日至2014年12月31日植入腹膜透析管并维持腹膜透析患者的临床资料,患者至少规律随访3个月。数据来自浙江省透析质量控制中心的透析登记系统。患者根据腹膜透析前有或无血液透析史分为两组:未血液透析组和临时血液透析组(血液透析时间少于3个月)。采用Kaplan-Meier生存曲线、Cox回归模型分析比较两组存活率及影响生存的相关因素。结果: 纳入腹膜透析患者共908例,其中未血液透析组732例、临时血液透析组176例。1年、2年、3年、4年患者存活率未血液透析组分别为96.2%、91.4%、88.0%、85.0%,临时血液透析组分别为92.8%、88.8%、78.2%、78.2%,差异均具有统计学意义(均P<0.05);两组患者技术存活率差异无统计学意义(P>0.05)。Cox回归模型分析结果提示患者临时血液透析史、高龄、血清白蛋白水平以及查尔森合并症指数评分是影响生存的独立危险因素。结论: 有血液透析史的腹膜透析患者长期存活率低于无血液透析史患者,临时血液透析是影响腹膜透析患者生存的独立危险因素之一,需重视患者的透析前计划与宣教。
关键词 ： 肾功能衰竭,慢性,  腹膜透析,  存活率,  肾透析,  预后,  回顾性研究    
Abstract：

Objective: To investigate the effects of interim hemodialysis (HD) on survival and clinical outcomes in patients with maintenance peritoneal dialysis (PD). Methods: The clinical data of 908 patients undergoing maintenance PD from January 2010 to December 2014 registered in Zhejiang Dialysis Regisration System were retrospectively analyzed. Among all PD patients, 176 cases received interim HD for less than 3 months, and then transferred to PD (transfer group) and 732 cases had initial PD (non-transfer group). The demographic parameters, biochemical data, comorbidity, details of peritonitis and transplantation were documented. Survival curves were made by the Kaplan-Meier method; univariate and multivariate analyses were performed with Cox proportional hazard regression model to identify risk factors of mortality. Results: Compared with patients in transfer group, patients in non-transfer group had significantly higher serum albumin and total Kt/V levels. The survival rate was significantly higher in non-transfer group, but there was no significant difference in technique survival between two groups. After multivariable adjustment, initial dialysis modality (HR=1.60, 95%CI: 1.01~2.56), age (HR=1.07, 95%CI:1.05~1.09) and serum albumin (HR=0.96, 95%CI: 0.93~0.99) and Charslon comorbidity index (HR=2.54, 95%CI:1.63~3.94) were independent factors for long-term survival. Conclusion: Patients who transfer to PD after interim HD have lower survival rate than patients who start with and are maintained on PD. HD is an independent risk factor for PD patients, therefore, patients with PD should be well informed and educated with dialysis protocols.
Key words： Kidney failure, chronic    Peritoneal dialysis    Survival rate    Renal dialysis    Prognosis    Retrospective studies
收稿日期: 2015-08-15     
CLC:  R692  
基金资助:

浙江省适宜技术转化项目(2013ZA018)
通讯作者: 寿张飞(1967-),男,博士,主任医师,博士生导师,从事肾内科腹膜透析及肾移植相关研究;E-mail:zfshou@zju.edu.cn     E-mail: zfshou@zju.edu.cn
作者简介: 边薇(1979-),女,学士,主治医师,从事肾内科腹膜透析研究;E-mail:bianweiweifeng@163.com
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边薇 等. 临时血液透析对维持性腹膜透析患者生存预后的影响[J]. 浙江大学学报（医学版）, 2016, 45(2): 195-200.
BIAN Wei, GUAN Jichao, XIE Xishao, TONG Jin, ZHANG Xiaohui, SHOU Zhangfei. Effects of interim hemodialysis on survival and clinical outcomes in patients with maintenance peritoneal dialysis. Journal of ZheJiang University(Medical Science), 2016, 45(2): 195-200.

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http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2016.03.13      或      http://www.zjujournals.com/xueshu/med/CN/Y2016/V45/I2/195

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