接受自动化腹膜透析治疗患者的结局：患者选择的影响

Karkar Ayman, Abdelrahman Mohammed

Kanoo Kidney Center, Dammam Medical Complex, Dammam, Saudi Arabia.

Saudi J Kidney Dis Transpl. 2011 Jan;22(1):40-8.

To determine the effect of selection of peritoneal dialysis patients who used auto-mated PD (APD) as a first renal replacement therapy (RRT) option, we studied two groups of adult chronic kidney disease (CKD) patients treated with APD over a period of 4 years: group 1 included 30 patients in whom APD was the first choice for RRT and group 2 included 40 patients transferred from failed hemodialysis (HD) treatment. Both groups were matched for the original causes of CKD and comorbid conditions. However, group 1 had significantly higher residual renal function (RRF) than group 2 [glomerular filtration rate (GFR) 11.85 ± 4 mL/min and urine output 995 ± 465 mL/day vs. 3.69 ± 3.7 mL/min and 340 ± 447 mL/day, respectively, P = 0.0001] and Kt/v (2.7 ± 0.7 vs. 1.9 ± 0.4, respectively, P = 0.006). Most of the patients were compliant with their APD prescription, performed ideal PD techniques, achieved adequate dialysis and fluid ultra-filtration, and experienced much less than average infectious and non-infectious complications. However, group 1 achieved better clinical outcome than group 2, including relatively higher survival rate and kidney transplantation, significantly fewer episodes of peritonitis per year (0.09 vs. 0.14, respectively, P = 0.0001), higher serum albumin (2.95 ± 0.3 vs. 2.7 ± 0.27 g/dL, respectively, P = 0.035), hemoglobin (11.5 ± 0.9 vs. 10.6 ± 0.7 g/dL, respectively, P = 0.022) and lower parathormone levels (283 ± 117 vs. 389 ± 269 pg/mL, respectively, P = 0.02). They also maintained significantly higher total fluid removal compared to group 2 (1120 ± 330 vs. 560 ± 300 mL/day, respectively, P = 0.004), higher RRF (GFR 8 ± 2.6 mL/min vs. 1.8 ± 2.4 mL/min, respectively, P = 0.0001), and urine output (556 ± 447 mL/day vs. 240 ± 347 mL/day, respectively, P = 0.004), and significantly higher Kt/v (2.8 ± 0.7 vs. 1.9 ± 0.4, respectively, P = 0.2). In conclusion, in CKD patients, PD is a viable initial modality of RRT, and with better RRF may have a better outcome than as a secondary choice.

为了确定选择使用自动化腹膜透析（APD）作为初始肾脏替代治疗（RRT）方案的腹膜透析患者的效果，我们研究了两组接受APD治疗4年的成年慢性肾脏病（CKD）患者：第1组包括30例将APD作为RRT首选的患者，第2组包括40例从失败的血液透析（HD）治疗中转来的患者。两组在CKD的原始病因和合并症方面相匹配。然而，第1组的残余肾功能（RRF）明显高于第2组[肾小球滤过率（GFR）分别为11.85±4 mL/分钟和尿量995±465 mL/天，而第2组分别为3.69±3.7 mL/分钟和340±447 mL/天，P = 0.0001]以及Kt/v（分别为2.7±0.7和1.9±0.4，P = 0.006）。大多数患者遵守其APD处方，采用理想的腹膜透析技术，实现了充分的透析和液体超滤，并且经历的感染性和非感染性并发症远低于平均水平。然而，第1组的临床结局优于第2组，包括相对较高的生存率和肾移植率，每年腹膜炎发作次数明显更少（分别为0.09和0.14，P = 0.0001），血清白蛋白水平更高（分别为2.95±0.3和2.7±0.27 g/dL，P = 0.035），血红蛋白水平更高（分别为11.5±0.9和10.6±0.7 g/dL，P = 0.022）以及甲状旁腺激素水平更低（分别为283±117和389±269 pg/mL，P = 0.02）。与第2组相比，他们还保持了明显更高的总液体清除量（分别为1120±330和560±300 mL/天，P = 0.004），更高的RRF（GFR分别为8±2.6 mL/分钟和1.8±2.4 mL/分钟，P = 0.0001）以及尿量（分别为556±447 mL/天和240±347 mL/天，P = 0.004），并且Kt/v明显更高（分别为2.8±0.7和1.9±0.4，P = 0.2）。总之，在CKD患者中，腹膜透析是一种可行的初始RRT方式，并且具有更好的RRF时可能比作为次要选择具有更好的结局。