Wiggins Kathryn J, McDonald Stephen P, Brown Fiona G, Rosman Johan B, Johnson David W
Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia.
Nephrol Dial Transplant. 2007 Oct;22(10):3005-12. doi: 10.1093/ndt/gfm324. Epub 2007 Jun 2.
High transporter status is associated with reduced survival of patients receiving peritoneal dialysis (PD). This may be due primarily to the development of complications related to the PD process, in which case the survival disadvantage may not persist following transfer to haemodialysis (HD). In this study, we aimed to assess the impact of peritoneal membrane transporter status on patient survival and the likelihood of return to PD following transfer from PD to HD.
The Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry was searched to identify all patients between 1 April 1999 and 31 March 2004 who had received PD and subsequently transferred to HD, in whom an incident 4 h dialysate: plasma creatinine ratio was recorded. A Cox proportional hazards model was used to identify factors significantly associated with patient and technique survival after commencement of HD.
A total of 918 patients were included in the analysis. On multivariate Cox regression analysis there was no difference in survival between transport groups relative to the reference group of low average transporters (adjusted hazard ratio (HR) 0.71, 95% CI 0.42-1.19, P = 0.19, HR 0.94, 95% CI 0.63-1.38, P = 0.73 and HR 0.24, 95% CI 0.06-1.01, P = 0.051 for high, high average and low transporter groups, respectively). Significant predictors of mortality were duration of PD more than 22 months (HR 2.32, 95% CI 1.24-4.33, P = 0.01), increasing age, late referral to a nephrologist and a history of diabetes mellitus. The likelihood of returning to PD was increased if initial PD technique failure was due to mechanical complications compared with all other causes of failure [HR 3.65 (95% CI 2.78-4.79) P < 0.001] and decreased with higher body mass index [HR 0.97 per kg/m(2) (95% CI 0.94-0.99), P = 0.01] and the 4 h dialysate: plasma creatinine ratio considered as a continuous variable [4 h D:P Cr; HR 0.32 per unit (95% CI 0.12-0.89), P = 0.03].
The survival disadvantage associated with high peritoneal membrane transport status during PD treatment does not persist following transfer to HD. Early transfer to HD may be beneficial in this patient group.
高转运状态与接受腹膜透析（PD）患者的生存率降低相关。这可能主要归因于与PD治疗过程相关并发症的发生，在这种情况下，转至血液透析（HD）后生存劣势可能不会持续存在。在本研究中，我们旨在评估腹膜转运状态对患者生存以及从PD转至HD后回归PD可能性的影响。
检索澳大利亚和新西兰透析与移植（ANZDATA）登记处，以确定1999年4月1日至2004年3月31日期间所有接受过PD并随后转至HD的患者，这些患者记录了首次4小时透析液：血浆肌酐比值。使用Cox比例风险模型确定HD开始后与患者和技术生存显著相关的因素。
共918例患者纳入分析。多因素Cox回归分析显示，与低平均转运者参考组相比，各转运组间生存率无差异（高、高平均和低转运组的调整风险比[HR]分别为0.71、95%CI 0.42 - 1.19、P = 0.19；HR 0.94、95%CI 0.63 - 1.38、P = 0.73；HR 0.24、95%CI 0.06 - 1.01、P = 0.051）。死亡的显著预测因素为PD持续时间超过22个月（HR 2.32、95%CI 1.24 - 4.33、P = 0.01）、年龄增加、肾病科医生转诊延迟以及糖尿病史。与所有其他失败原因相比，如果初始PD技术失败是由于机械并发症，则回归PD的可能性增加[HR 3.65（95%CI 2.78 - 4.79），P < 0.001]，且随着体重指数升高而降低[每kg/m² HR 0.97（95%CI 0.94 - 0.99），P = 0.01]，4小时透析液：血浆肌酐比值作为连续变量时也是如此[4小时D:P Cr；每单位HR 0.32（95%CI 0.12 - 0.89），P = 0.03]。
PD治疗期间与高腹膜转运状态相关的生存劣势在转至HD后不会持续存在。对于该患者群体，早期转至HD可能有益。
