Rocco Michael V, Frankenfield Diane L, Prowant Barbara, Frederick Pamela, Flanigan Michael J
Wake Forest University School of Medicine Winston-Salem, North Carolina 27157-1053, USA.
Perit Dial Int. 2002 May-Jun;22(3):371-9.
Potential risk factors for 1-year mortality, including the peritoneal component of dialysis dose, residual renal function, demographic data, hematocrit, serum albumin, dialysate-to-plasma creatinine ratio, and blood pressure, were examined in a national cohort of peritoneal dialysis patients randomly selected for the Centers for Medicare and Medicaid Services End-Stage Renal Disease (ESRD) Core Indicators Project.
The study involved retrospective analysis of a cohort of 1,219 patients receiving chronic peritoneal dialysis who were alive on December 31, 1996.
During the 1-year follow-up period, 275 patients were censored and 200 non censored patients died. Among the 763 patients who had at least one calculable adequacy measure, the mean [+/- standard deviation (SD)] weekly Kt/V urea was 2.16 +/- 0.61 and the mean weekly creatinine clearance was 66.1 +/- 24.4 L/1.73 m2. Excluding the 365 patients who were anuric, the mean (+/- SD) urinary weekly Kt/V urea was 0.64 +/- 0.52 (median: 0.51) and the mean (+/- SD) urinary weekly creatinine clearance was 31.0 +/- 23.3 L/1.73 m2 (median: 26.3 L/1.73 m2). By Cox proportional hazard modeling, lower quartiles of renal Kt/V urea were predictive of 1-year mortality; lower quartiles of renal creatinine clearance were of borderline significance for predicting 1-year mortality. The dialysate component of neither the weekly creatinine clearance nor the weekly Kt/V urea were predictive of 1-year mortality. Other predictors of 1-year mortality (p < 0.01) included lower serum albumin level, older age, and the presence of diabetes mellitus as the cause of ESRD, and, for the creatinine clearance model only, lower diastolic blood pressure.
Residual renal function is an important predictor of 1-year mortality in chronic peritoneal dialysis patients.
在一项为医疗保险和医疗补助服务中心终末期肾病（ESRD）核心指标项目随机选取的全国性腹膜透析患者队列中，研究了1年死亡率的潜在风险因素，包括透析剂量的腹膜部分、残余肾功能、人口统计学数据、血细胞比容、血清白蛋白、透析液与血浆肌酐比值以及血压。
该研究对1996年12月31日存活的1219例接受慢性腹膜透析的患者队列进行回顾性分析。
在1年随访期内，275例患者被 censored ，200例未被 censored 的患者死亡。在763例至少有一项可计算充分性指标的患者中，平均[±标准差（SD）]每周尿素Kt/V为2.16±0.61，平均每周肌酐清除率为66.1±24.4L/1.73m²。排除365例无尿患者后，平均（±SD）尿每周尿素Kt/V为0.64±0.52（中位数：0.51），平均（±SD）尿每周肌酐清除率为31.0±23.3L/1.73m²（中位数：26.3L/1.73m²）。通过Cox比例风险模型，肾脏尿素Kt/V的较低四分位数可预测1年死亡率；肾脏肌酐清除率的较低四分位数对预测1年死亡率具有临界显著性。每周肌酐清除率和每周尿素Kt/V的透析液部分均不能预测1年死亡率。1年死亡率的其他预测因素（p<0.01）包括较低的血清白蛋白水平、较高年龄以及作为ESRD病因的糖尿病，并且仅对于肌酐清除率模型而言，较低的舒张压也是预测因素。
残余肾功能是慢性腹膜透析患者1年死亡率的重要预测因素。
