技术失败对接受持续性非卧床腹膜透析的黑人患者治疗结果的影响。

The effect of technique failure on outcome in black patients on continuous ambulatory peritoneal dialysis.

作者信息

Kim George C, Vonesh Edward F, Korbet Stephen M

机构信息

Department of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.

出版信息

Perit Dial Int. 2002 Jan-Feb;22(1):53-9.

PMID:11929145

Abstract

BACKGROUND

We previously reported that, while black patients have a better patient survival than white patients on peritoneal dialysis (PD), they also have a significantly higher technique failure rate (39% vs 8%, p < 0.0001). The purpose of this study was to determine the effect of technique failure/transfer to hemodialysis (HD) on patient survival in black PD patients.

METHODS

We retrospectively evaluated 137 incident black patients entering our PD program from January 1987 to December 1997. During the course of follow-up, 82 (60%) patients remained on PD (PD group) while 55 (40%) patients were permanently transferred to HD (PD-HD group). The primary outcome measured was patient survival.

RESULTS

Average age was 49 +/- 15 years, 42% were male, and 40% had diabetes mellitus. At baseline, serum creatinine was 10.8 +/- 5.4 mg/dL, serum albumin 3.4 +/- 0.7 g/dL, body mass index 27.3 +/- 6.5 kg/m2, peritoneal transport status was high in 18% and high-average in 61%, and residual glomerular filtration rate was 3.4 +/- 3.5 mL/minute. There were no significant differences in clinical features, nutritional status, peritoneal transport, residual renal function, or dialysis adequacy at baseline between the PD group and PD-HD group. While a greater proportion of patients transferring to HD had cardiac disease (53% vs 32%, p < 0.05), there were no other significant differences in 15 comorbid conditions assessed at baseline. The primary reason for transfer was peritonitis (64%) and the overall peritonitis rate in the PD-HD group was significantly higher than in the PD group (2.21 vs 1.17 episodes/patient-year, p < 0.0001). Overall follow-up was 34 +/- 25 months for PD group and 44 +/- 26 months for PD-HD group (p < 0.01), with a mean time on PD prior to transfer to HD of 22 +/- 18 months. During the course of follow-up, there were no significant differences between the two groups in the number of patients transplanted or deaths. Patient survival at 1, 2, and 5 years was 91%, 80%, and 57% for PD group and 96%, 92%, and 55% for PD-HD group [p = not significant (NS)]. A risk-adjusted time-dependent Cox regression analysis resulted in an adjusted relative risk of death that was not significantly different for those who transferred from PD to HD versus those who remained on PD (relative risk 1.49; 95% confidence interval 0.77-2.89; p = NS).

CONCLUSIONS

In black patients on PD, transfer to HD is not associated with any significant difference in patient survival compared to patients remaining on PD. While a high rate of peritonitis predisposes to technique failure, we found no features at baseline predictive of patients at greatest risk to fail PD. Since technique failure does not portend a poorer prognosis, PD remains a viable option for black patients entering an end-stage renal disease program.

摘要

背景

我们之前报道过，虽然黑人患者在腹膜透析（PD）治疗中的患者生存率高于白人患者，但他们的技术失败率也显著更高（39% 对 8%，p < 0.0001）。本研究的目的是确定技术失败/转为血液透析（HD）对黑人PD患者生存率的影响。

方法

我们回顾性评估了1987年1月至1997年12月进入我们PD项目的137例初治黑人患者。在随访过程中，82例（60%）患者继续接受PD治疗（PD组），而55例（40%）患者永久转为HD治疗（PD-HD组）。测量的主要结局是患者生存率。

结果

平均年龄为49±15岁，42%为男性，40%患有糖尿病。基线时，血清肌酐为10.8±5.4mg/dL，血清白蛋白为3.4±0.7g/dL，体重指数为27.3±6.5kg/m²，18%的患者腹膜转运状态为高转运，61%为高-平均转运，残余肾小球滤过率为3.4±3.5mL/分钟。PD组和PD-HD组在基线时的临床特征、营养状况、腹膜转运、残余肾功能或透析充分性方面无显著差异。虽然转为HD治疗的患者中心脏病患者比例更高（53% 对 32%，p < 0.05），但在基线时评估的15种合并症方面无其他显著差异。转为HD治疗的主要原因是腹膜炎（64%），PD-HD组的总体腹膜炎发生率显著高于PD组（2.21对1.17次/患者年，p < 0.0001）。PD组的总体随访时间为34±25个月，PD-HD组为44±26个月（p < 0.01），转为HD治疗前接受PD治疗的平均时间为22±18个月。在随访过程中，两组在移植患者数量或死亡人数方面无显著差异。PD组1年、2年和5年的患者生存率分别为91%、80%和57%，PD-HD组分别为96%、92%和55%[p = 无显著差异（NS）]。风险调整后的时间依赖性Cox回归分析结果显示，从PD转为HD治疗的患者与继续接受PD治疗的患者相比，调整后的死亡相对风险无显著差异（相对风险1.49；95%置信区间0.77 - 2.89；p = NS）。