Fang Wei, Qian Jiaqi, Lin Aiwu, Rowaie Fadel, Ni Zhaohui, Yao Qiang, Bargman Joanne M, Oreopoulos Dimitrios G
Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Nephrol Dial Transplant. 2008 Dec;23(12):4021-8. doi: 10.1093/ndt/gfn372. Epub 2008 Sep 12.
Objective. We compared patient characteristics, dialysis practice patterns and outcomes of peritoneal dialysis (PD) patients between one Chinese centre and one Canadian centre to determine whether observed differences in demographics and practices are associated with patient and technique survival.
This study included all patients who started on PD between 1 January 2000 and 31 December 2004 at the University Health Network, University of Toronto, Canada and Renji Hospital, Shanghai Jiao Tong University School of Medicine, China. They were followed up from the date of PD initiation until death, cessation of PD, transfer to other centres or to the end of the study (31 December 2006).
We studied 496 patients, 256 from the Canadian centre and 240 from the Chinese centre. Canadian patients were older and more likely to have diabetes and cardiovascular comorbidities at the initiation of PD, while the Chinese patients had lower residual renal function (RRF). More Canadian patients were treated with APD, whereas all Chinese patients were on CAPD with a lower PD volume. Crude patient survival rates at 1, 2, 3 and 5 years were similar between the two centres: 90%, 79%, 72% and 61% for Canadian and 90%, 79%, 71% and 64% for Chinese patients, respectively. After adjustment for demographic and clinical variables, there is no significant difference in mortality between Chinese patients and Canadian patients. Age, cardiovascular disease, diabetes, RRF and serum albumin were independent predictors of patient survival. The death-censored technique survival rates were significantly lower among the Canadian patients compared to Chinese patients. Chinese patients showed a lower risk of technique failure (HR 0.491, 95% CI 0.269-0.898, P = 0.021) after adjustment for patient characteristics. Chinese centre, BMI, serum albumin and gender were independent predictors of technique survival. The average peritonitis rate was one episode every 36.1 patient-months in Canadian patients and one episode every 60.6 patient-months in their Chinese counterparts.
Patient characteristics, dialysis practice patterns and outcomes vary between Canadian and Chinese patients. The variability in patient outcomes between these two centres indicates that further improvements may be possible in both centres. We have identified several areas for improving outcomes.
目的。我们比较了中国一家中心和加拿大一家中心腹膜透析（PD）患者的特征、透析实践模式及结局，以确定观察到的人口统计学和实践差异是否与患者生存率及技术生存率相关。
本研究纳入了2000年1月1日至2004年12月31日期间在加拿大多伦多大学健康网络和中国上海交通大学医学院附属仁济医院开始接受PD治疗的所有患者。从开始PD治疗之日起对他们进行随访，直至死亡、停止PD治疗、转至其他中心或研究结束（2006年12月31日）。
我们研究了496例患者，其中256例来自加拿大中心，240例来自中国中心。加拿大患者在开始PD治疗时年龄较大，更易患糖尿病和有心血管合并症，而中国患者的残余肾功能（RRF）较低。更多加拿大患者接受自动化腹膜透析（APD）治疗，而所有中国患者均接受持续性非卧床腹膜透析（CAPD）且透析剂量较低。两个中心1年、2年、3年和5年的粗患者生存率相似：加拿大患者分别为90%、79%、72%和61%，中国患者分别为90%、79%、71%和64%。在对人口统计学和临床变量进行调整后，中国患者和加拿大患者的死亡率无显著差异。年龄、心血管疾病、糖尿病、RRF和血清白蛋白是患者生存的独立预测因素。与中国患者相比，加拿大患者经死亡校正后的技术生存率显著较低。在对患者特征进行调整后，中国中心、体重指数（BMI）、血清白蛋白和性别是技术生存的独立预测因素。加拿大患者的平均腹膜炎发生率为每36.1患者月1次，中国患者为每60.6患者月1次。
加拿大患者和中国患者在患者特征、透析实践模式及结局方面存在差异。这两个中心患者结局的差异表明两个中心都有可能进一步改善。我们已经确定了几个改善结局的领域。
