Wang Tao, Tziviskou Effie, Chu Maggie, Bargman Joanne, Jassal Vanita, Vas Stephen, Oreopoulos Dimitrios G
Home Peritoneal dialysis Unit, The Toronto Hospital (General and Western Division), University of Toronto, Ontario, Canada.
Int Urol Nephrol. 2003;35(2):267-74. doi: 10.1023/b:urol.0000020286.83411.d1.
Recently it has been suggested that the survival of dialysis patients may differ among different races. Both registry data and data from Asian countries indicates that Asians on peritoneal dialysis may survive longer than their Caucasian counterparts. In the present study, we performed a detailed analysis of survival differences between oriental Asians and Caucasians on peritoneal dialysis in our multiethnic, multicultural program.
Retrospectively we analyzed the survival data for patients who started peritoneal dialysis after January 1, 1996 and before December 31, 1999, in our hospital. They were followed for at least for two years. Excluded from the present analysis were those who survived for less than three months on peritoneal dialysis. The patient demographic characteristics, comorbidities, and residual renal function at the start of dialysis were collected. Indices for adequacy of dialysis were collected 1-3 months after the initiation of dialysis. Actuarial survival rates were determined by the Kaplan-Meier method. The Cox proportional hazards model was used to classify risk factors for a high mortality.
There were 87 Caucasians and 29 Oriental Asian peritoneal dialysis patients. No differences were found in age, gender, primary renal disease, and residual renal function between the two groups. The Caucasians had significantly higher body surface area and urea volume and higher incidence of cardiovascular diseases. Even with slightly higher dialysis dose, the peritoneal creatinine clearance was significantly lower among the Caucasians than among Asians. There was no difference in the peritoneal D/P value between the two groups. However, compared to the Caucasians, the 24hr peritoneal fluid removal and total fluid removal volumes were significantly lower in the Asian patients. The one, two, three and four year survival rates were 95.8%, 91%, 86% and 80% for Asians and 91.3%, 78.1%, 64.7% and 54.1% for Caucasians. Significant predictors for a higher mortality were the presence of cardiovascular disease (42% increase in risk), Caucasians (39% increase in risk) and older age (37% increase in risk for age older than 65).
Our study confirms that oriental Asians on peritoneal dialysis patients survive much longer than their Caucasian counterparts; this was partly due to the fact that Asian patients have less cardiovascular disease when they began peritoneal dialysis. Due to their smaller body size, the Asians tended to have a higher peritoneal small solute clearances despite their smaller dialysis doses, indicating that, to achieve the same solute clearance targets, Asians need a smaller dialysis dose compared to Caucasians.
最近有人提出，不同种族的透析患者生存率可能存在差异。登记数据和来自亚洲国家的数据均表明，接受腹膜透析的亚洲人可能比白种人存活时间更长。在本研究中，我们在我们这个多民族、多元文化的项目中，对东方亚洲人和白种人腹膜透析患者的生存差异进行了详细分析。
我们回顾性分析了1996年1月1日至1999年12月31日在我院开始腹膜透析的患者的生存数据。对他们进行了至少两年的随访。本分析排除了腹膜透析存活时间少于三个月的患者。收集了患者的人口统计学特征、合并症以及透析开始时的残余肾功能。在透析开始1 - 3个月后收集透析充分性指标。采用Kaplan - Meier法确定精算生存率。使用Cox比例风险模型对高死亡率的危险因素进行分类。
有87名白种人和29名东方亚洲腹膜透析患者。两组在年龄、性别、原发性肾脏疾病和残余肾功能方面未发现差异。白种人的体表面积和尿素清除量显著更高，心血管疾病发病率更高。即使透析剂量略高，白种人的腹膜肌酐清除率仍显著低于亚洲人。两组之间的腹膜D/P值没有差异。然而，与白种人相比，亚洲患者的24小时腹膜液清除量和总液体清除量显著更低。亚洲人的1年、2年、3年和4年生存率分别为95.8%、91%、86%和80%，白种人分别为91.3%、78.1%、64.7%和54.1%。较高死亡率的显著预测因素是存在心血管疾病（风险增加42%）、白种人（风险增加39%）和老年（65岁以上风险增加37%）。
我们的研究证实，接受腹膜透析的东方亚洲患者比白种人存活时间长得多；部分原因是亚洲患者开始腹膜透析时心血管疾病较少。由于体型较小，尽管透析剂量较小，亚洲人的腹膜小分子溶质清除率往往较高，这表明，为达到相同的溶质清除目标，并与白种人相比，亚洲人需要的透析剂量更小。
