Division of Nephrology, Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Clin J Am Soc Nephrol. 2011 Mar;6(3):537-42. doi: 10.2215/CJN.00470110. Epub 2011 Mar 10.
We compared the decline of RRF in patients starting dialysis on APD with those starting on CAPD, because a faster decline on APD has been suggested.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: NECOSAD patients starting dialysis on APD or CAPD with RRF at baseline were included and followed for 3 years. Residual GFR (rGFR) was the mean of urea and creatinine clearances. Differences in yearly decline of rGFR were estimated in analyses with linear repeated measures models, whereas the risk of complete loss of RRF was estimated by calculating hazard ratios (HRs) for APD compared with CAPD. As-treated (AT) and intention-to-treat (ITT) designs were used. All of the analyses were adjusted for age, gender, comorbidity, and primary kidney disease and stratified according to follow-up and mean baseline GFR.
The 505 CAPD and 78 APD patients had no major baseline differences. No differences were found in the analyses on yearly decline of rGFR. APD patients did have a higher risk of losing RRF in the first year (ITT crude HR 2.43 [confidence interval 95%, 1.48 to 4.00], adjusted 2.66 [1.60 to 4.44]; AT crude 1.89 [1.04 to 3.45], adjusted 2.15 [1.16 to 3.98]). The higher risk of losing all RRF was most pronounced in patients with the highest rGFR at baseline (ITT; crude 3.91 [1.54 to 9.94], adjusted 1.85 to 14.17).
The risk of losing RRF is higher for patients starting dialysis on APD compared with those starting on CAPD, especially in the first year.
我们比较了开始腹膜透析（APD）和持续不卧床腹膜透析（CAPD）治疗的患者的 RRF 下降情况，因为有研究表明 APD 治疗下的 RRF 下降更快。
设计、设置、参与者和测量：纳入了基线时即有 RRF 且开始腹膜透析治疗的 NECOSAD 患者，并随访 3 年。残余肾小球滤过率（rGFR）为尿素和肌酐清除率的平均值。采用线性重复测量模型进行分析，比较了 rGFR 每年下降的差异，通过计算与 CAPD 相比 APD 治疗的风险比（HR）来评估完全丧失 RRF 的风险。采用了按治疗（AT）和意向治疗（ITT）设计。所有分析均根据年龄、性别、合并症和原发病肾脏病进行了调整，并根据随访和基线平均 GFR 进行了分层。
505 例 CAPD 和 78 例 APD 患者的基线差异无统计学意义。rGFR 每年下降的分析中未发现差异。APD 患者在第一年丧失 RRF 的风险更高（ITT 粗 HR 2.43 [95%置信区间 1.48 至 4.00]，调整 HR 2.66 [1.60 至 4.44]；AT 粗 HR 1.89 [1.04 至 3.45]，调整 HR 2.15 [1.16 至 3.98]）。在基线 rGFR 最高的患者中，丧失所有 RRF 的风险更高（ITT；粗 HR 3.91 [1.54 至 9.94]，调整 HR 1.85 至 14.17）。
与 CAPD 相比，开始 APD 治疗的患者丧失 RRF 的风险更高，尤其是在第一年。
