儿科腹膜透析患者的预后和死亡风险因素。

Outcome and risk factors for mortality in pediatric peritoneal dialysis.

机构信息

Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, School of Medicine, Taipei, Taiwan.

出版信息

Perit Dial Int. 2010 Mar-Apr;30(2):233-9. doi: 10.3747/pdi.2008.00278. Epub 2010 Feb 11.

DOI:10.3747/pdi.2008.00278

PMID:20150582

Abstract

BACKGROUND

The mortality rate among children requiring renal replacement therapy is higher than in children without end-stage renal disease (ESRD). Some factors, such as hypoalbuminemia, high peritoneal transport rate, age, malnutrition, cardiovascular disease, and recurrent peritonitis, appear to be associated with lower survival in adult peritoneal dialysis patients. Data regarding risk factors of mortality in children with continuous ambulatory peritoneal dialysis (CAPD) are limited. The aims of this study were to analyze the clinical characteristics of patients and investigate if routinely used laboratory and clinical variables are independent risk factors for mortality in children on CAPD.

METHODS

We performed a retrospective chart analysis of pediatric ESRD patients on CAPD between January 1997 and September 2008. 29 patients undergoing CAPD for more than 3 months were enrolled. An analysis was performed on clinical and biochemical variables for survivors and nonsurvivors to identify potential risk factors for mortality.

RESULTS

Mean age was 12.18 +/- 4.57 years. During the follow-up period, 8 patients transferred to hemodialysis and 13 patients received deceased donor renal transplantation. By the end of the study, 5 patients had died. Actuarial survival rate at 2 and 5 years was 96.55% and 91.19% respectively. The major complication during therapy was peritonitis (1 episode/57.79 patient-months). In the univariate analysis, younger age at initiation of dialysis, presence of comorbid disease, higher peritoneal transport rate, increased protein losses through peritoneal dialysis, high total daily protein loss, hypoalbuminemia, and hypophosphatemia were variables associated with mortality in pediatric CAPD patients. However, in the multivariate analysis, only low serum albumin (b = -2.089, p = 0.006; hazard ratio 8.06, 95% confidence interval 0.028 - 0.546) was independently associated with mortality.

CONCLUSION

Mortality was low in our pediatric patients receiving CAPD. Hypoalbuminemia showed a significant association with death in CAPD patients.

摘要

背景

需要肾脏替代治疗的儿童死亡率高于没有终末期肾病（ESRD）的儿童。一些因素，如低白蛋白血症、高腹膜转运率、年龄、营养不良、心血管疾病和复发性腹膜炎，似乎与成人腹膜透析患者的生存率降低有关。关于接受持续不卧床腹膜透析（CAPD）治疗的儿童死亡风险因素的数据有限。本研究的目的是分析患者的临床特征，并探讨常规使用的实验室和临床变量是否是 CAPD 患儿死亡的独立危险因素。

方法

我们对 1997 年 1 月至 2008 年 9 月期间接受 CAPD 的儿科 ESRD 患者进行了回顾性图表分析。共纳入 29 例 CAPD 治疗时间超过 3 个月的患者。对幸存者和非幸存者的临床和生化变量进行分析，以确定死亡的潜在危险因素。

结果

平均年龄为 12.18±4.57 岁。在随访期间，8 例患者转为血液透析，13 例患者接受了已故供体肾移植。研究结束时，有 5 例患者死亡。2 年和 5 年的生存率分别为 96.55%和 91.19%。治疗期间的主要并发症是腹膜炎（1 例/57.79 例患者-月）。在单变量分析中，透析起始时年龄较小、合并症存在、较高的腹膜转运率、通过腹膜透析增加的蛋白丢失、总蛋白日丢失增加、低白蛋白血症和低磷血症与儿科 CAPD 患者的死亡率相关。然而，在多变量分析中，只有低血清白蛋白（b=-2.089，p=0.006；危险比 8.06，95%置信区间 0.028-0.546）与死亡率独立相关。