Stack Austin G, Molony Donald A, Rahman Noor S, Dosekun Akinsansoye, Murthy Bhamidipati
Division of Renal Diseases and Hypertension, Department of Internal Medicine, University of Texas Health Sciences Center at Houston, Houston, Texas, USA.
Kidney Int. 2003 Sep;64(3):1071-9. doi: 10.1046/j.1523-1755.2003.00165.x.
It is hypothesized, but not proven, that peritoneal dialysis might be the optimal treatment for end-stage renal disease (ESRD) patients with established congestive heart failure (CHF) through better volume regulation compared with hemodialysis.
National incidence data on 107,922 new ESRD patients from the Center for Medicare and Medicaid Services (CMS) Medical Evidence Form were used to test the hypothesis that peritoneal dialysis was superior to hemodialysis in prolonging survival of patients with CHF. Nonproportional Cox regression models evaluated the relative hazard of death for patients with and without CHF by dialysis modality using primarily the intent-to-treat but also the as-treated approach. Diabetics and nondiabetics were analyzed separately.
The overall prevalence of CHF was 33% at ESRD initiation. There were 27,149 deaths (25.2%), 5423 transplants (5%), and 3753 (3.5%) patients lost to follow-up over 2 years. Adjusted mortality risks were significantly higher for patients with CHF treated with peritoneal dialysis than hemodialysis [diabetics, relative risk (RR) = 1.30, 95% confidence interval (CI) 1.20 to 1.41; nondiabetics, RR = 1.24, 95% CI 1.14 to 1.35]. Among patients without CHF, adjusted mortality risk were higher only for diabetic patients treated with peritoneal dialysis compared with hemodialysis (RR = 1.11, 95% CI 1.02 to 1.21) while nondiabetics had similar survival on peritoneal dialysis or hemodialysis (RR = 0.97, 95% CI 0.91 to 1.04).
New ESRD patients with a clinical history of CHF experienced poorer survival when treated with peritoneal dialysis compared with hemodialysis. These data suggest that peritoneal dialysis may not be the optimal choice for new ESRD patients with CHF perhaps through impaired volume regulation and worsening cardiomyopathy.
有假设认为，对于已确诊充血性心力衰竭（CHF）的终末期肾病（ESRD）患者，腹膜透析通过比血液透析更好的容量调节可能是最佳治疗方法，但尚未得到证实。
利用医疗保险和医疗补助服务中心（CMS）医疗证据表格中107,922例新ESRD患者的全国发病率数据，检验腹膜透析在延长CHF患者生存期方面优于血液透析这一假设。非比例Cox回归模型使用主要的意向性分析以及实际治疗分析方法，评估按透析方式分组的有CHF和无CHF患者的相对死亡风险。糖尿病患者和非糖尿病患者分别进行分析。
ESRD起始时CHF的总体患病率为33%。在2年多的时间里，有27,149例死亡（25.2%），5423例移植（5%），3753例（3.5%）患者失访。接受腹膜透析治疗的CHF患者校正后的死亡风险显著高于接受血液透析的患者[糖尿病患者，相对风险（RR）=1.30，95%置信区间（CI）1.20至1.41；非糖尿病患者，RR = 1.24，95% CI 1.14至1.35]。在无CHF的患者中，与血液透析相比，仅接受腹膜透析治疗的糖尿病患者校正后的死亡风险更高（RR = 1.11，95% CI 1.02至1.21），而非糖尿病患者在腹膜透析或血液透析中的生存率相似（RR = 0.97，95% CI 0.91至1.04）。
与血液透析相比，有CHF临床病史的新ESRD患者接受腹膜透析治疗时生存期较差。这些数据表明，腹膜透析可能不是有CHF的新ESRD患者的最佳选择，可能是由于容量调节受损和心肌病恶化。
