D'Adamo G, Di Napoli A, Amoroso F, De Martino A, Della Grotta F, Filippini A, Mauro M, Rosa M, Santoboni A, Scaccia F, Di Lallo D, Miceli M, Spinelli C
U.O.C. Nefrologia e Dialisi, Ospedale S. Spirito, Roma.
G Ital Nefrol. 2003 Jul-Aug;20(4):381-7.
In Lazio, only about 5% of uremic patients are on peritoneal dialysis (PD). The present study focuses on the parameters of PD selection, the treatment schedules, and the clinical outcomes of PD patients in the nine public facilities offering a PD program. A cohort of 249 first-time PD patients, from July 1, 1994 to December 31, 2000, was retrospectively considered.
For the enrollment of the patients, the Regional Dialysis Registry databank was consulted. On December 31, 2000, a systematic review of patient charts was performed to extract the reasons for the PD choice, details of PD schedule, peritonitis episodes, reasons for drop-out, and patient survival rates. In regard to technique success-defined as the probability of having a patient alive on PD-change of modality and death were considered as final events. In regard to patient survival, only death, even in the first 2 months after a shift to hemodialysis, was considered the end point.
The main PD selection reasons were patient and/or nephrologist preference in 90% of cases. One-hundred eighty-nine patients (76%) had been started on CAPD. During the follow-up, 38.2% dialysis schedules had been modified at least once. At the end of follow-up, 41.2% patients were on APD. The peritonitis rate was one episode per 30 patient-months (1 per 27 patient-months in CAPD; 1 per 37 patient-months in APD; p = 0.08). The technique success rate was 66.3% after 2 years and 49.8% after 3 years. The patient survival rate was 81.1% after 2 years and 68.7% after 3 years.
Patients chose PD as a first dialysis treatment mainly because of reasons unrelated to their clinical status. The technique's success, patient mortality rates, and the peritonitis rate do not explain the low PD diffusion in the region. The peritonitis rate meets the target criteria for excellence recommended by the Italian Society of Nephrology. The observed outcomes may have been favored by the selection of motivated patients and by the increased use of APD.
在拉齐奥地区，只有约5%的尿毒症患者接受腹膜透析（PD）治疗。本研究聚焦于九个提供腹膜透析项目的公共机构中，腹膜透析患者的选择参数、治疗方案及临床结局。回顾性分析了1994年7月1日至2000年12月31日期间的249例首次接受腹膜透析的患者队列。
通过查阅地区透析登记数据库来纳入患者。2000年12月31日，对患者病历进行系统审查，以提取选择腹膜透析的原因、腹膜透析方案细节、腹膜炎发作情况、退出原因及患者生存率。技术成功定义为患者在腹膜透析治疗中存活、转至其他透析方式及死亡的概率，视为最终事件。对于患者生存情况，仅将死亡视为终点，即使是转为血液透析后的前两个月内死亡。
90%的病例中，选择腹膜透析的主要原因是患者和/或肾病科医生的偏好。189例患者（76%）开始接受持续性不卧床腹膜透析（CAPD）治疗。随访期间，38.2%的透析方案至少修改过一次。随访结束时，41.2%的患者接受自动化腹膜透析（APD）治疗。腹膜炎发生率为每30患者月1次发作（CAPD为每27患者月1次；APD为每37患者月1次；p = 0.08）。2年后技术成功率为66.3%，3年后为49.8%。2年后患者生存率为81.1%，3年后为68.7%。
患者选择腹膜透析作为首次透析治疗的主要原因与其临床状况无关。该技术的成功率、患者死亡率和腹膜炎发生率并不能解释该地区腹膜透析普及率较低的原因。腹膜炎发生率符合意大利肾脏病学会推荐的卓越目标标准。观察到的结果可能得益于对有积极性患者的选择以及自动化腹膜透析使用的增加。
