小分子溶质清除率对无尿腹膜透析患者生存率的影响。

The effect of small solute clearances on survival of anuric peritoneal dialysis patients.

作者信息

Bhaskaran S, Schaubel D E, Jassal S V, Thodis E, Singhal M K, Bargman J M, Vas S I, Oreopoulos D G

机构信息

Division of Nephrology, The Toronto Hospital, Ontario, Canada.

出版信息

Perit Dial Int. 2000 Mar-Apr;20(2):181-7.

PMID:10809241

Abstract

OBJECTIVE

Primarily, to determine whether peritoneal small solute clearance is related to patient and technique survival among anuric peritoneal dialysis [continuous ambulatory (CAPD) and automated peritoneal dialysis (APD)] patients. A secondary goal was to describe the ability to attain Dialysis Outcomes Quality Initiative (DOQI) targets among anuric patients on peritoneal dialysis.

DESIGN

Retrospective cohort study via chart reviews.

SETTING

Peritoneal Dialysis Unit of Toronto Hospital (Western Division).

PATIENTS

The study included 122 CAPD and APD patients between January 1992 and September 1997, with 24-hour urine volume less than 100 mL, or renal creatinine clearance (CCr) less than 1 mL/minute. Adequacy data were available for 115 patients.

OUTCOME MEASURES

Mortality and technique failure (TF). Regression analysis was used to estimate the mortality and TF rate ratios (RR) for peritoneal Kt/V urea (pKt/V) and pCCr, adjusting for age, gender, diabetes, months of follow-up prior to anuria, albumin, transport status, coronary artery disease, cardiovascular disease, and peripheral vascular disease.

RESULTS

Fifty seven per cent (51/89) of patients on CAPD and 81% (21/26) on APD had a weekly pKt/V > or = 2 and > or = 2.2, respectively (DOQI targets); whereas only 35% on CAPD (31/89) and 35% (9/26) on APD had a weekly pCCr > or = 60 U1.73 m2 and 66 L/1.73 m2, respectively. Median follow-up times among patients were 16.5 and 19.5 months pre- and postanuria, respectively. Patients with pKt/V > or = 1.85 experienced a strong decrease in patient mortality (RR = 0.54, p= 0.10); the effect was less pronounced for pCCr > or = 50 L/1.73 m2 (RR = 0.63, p = 0.25). No relationship was observed between pKt/V or pCCr and TF.

CONCLUSION

Mortality was noticeably less frequent among patients with a pKt/V > or = 1.85 compared with those with a Kt/W < 1.85 (p = 0.10). Given the magnitude of the association, the failure to observe statistical significance relates to the size of the patient cohort. Our results imply that it is, in fact, possible to achieve DOQI targets among anuric patients on peritoneal dialysis.

摘要

目的

主要确定在无尿的腹膜透析（持续非卧床腹膜透析（CAPD）和自动化腹膜透析（APD））患者中，腹膜小溶质清除率是否与患者生存率及技术生存率相关。次要目标是描述无尿的腹膜透析患者达到透析预后质量倡议（DOQI）目标的能力。

设计

通过病历回顾进行回顾性队列研究。

地点

多伦多医院（西区）腹膜透析科。

患者

本研究纳入了1992年1月至1997年9月期间的122例CAPD和APD患者，其24小时尿量少于100 mL，或肾脏肌酐清除率（CCr）低于1 mL/分钟。115例患者有充分性数据。

观察指标

死亡率和技术失败（TF）。采用回归分析估计腹膜Kt/V尿素（pKt/V）和pCCr的死亡率及TF率比（RR），并对年龄、性别、糖尿病、无尿前的随访月数、白蛋白、转运状态、冠状动脉疾病、心血管疾病和外周血管疾病进行校正。

结果

CAPD患者中有57%（51/89）、APD患者中有81%（21/26）的每周pKt/V分别≥2和≥2.2（DOQI目标）；而CAPD患者中只有35%（31/89）、APD患者中只有35%（9/26）的每周pCCr分别≥60 U/1.73 m²和66 L/1.73 m²。患者无尿前和无尿后的中位随访时间分别为16.5个月和19.5个月。pKt/V≥1.85的患者死亡率显著降低（RR = 0.54，p = 0.10）；对于pCCr≥50 L/1.73 m²，效果则不那么明显（RR = 0.63，p = 0.25）。未观察到pKt/V或pCCr与TF之间的关系。