Nephrologisches Zentrum Mettmann, Mettmann, Germany.
Nephrol Dial Transplant. 2012 Jan;27(1):375-80. doi: 10.1093/ndt/gfr262. Epub 2011 May 28.
The impact of dialysis modality on outcome, especially on infection early in the course of dialysis, in unplanned acute dialysis initiation has not been well evaluated. The aim of the study was to compare the rates and causes of mortality and morbidity in incident dialysis patients started unplanned acute peritoneal dialysis (PD) or haemodialysis (HD).
In this observational cohort study, incident dialysis patients with initiation of unplanned and acute PD (n = 66) or HD (n = 57) at a single centre from March 2005 to June 2010 were included and followed up for 6 months (0-183 days, mean follow-up time 4.72 months). For PD, surgically placed Tenckhoff catheters were used. All HD patients were dialysed with a central venous catheter (non-tunnelled or tunnelled). There were no significant differences in terms of gender, age and prevalence of diabetes mellitus in either group. The prevalence of heart failure [New York Heart Association (NYHA) Stage III-IV] was significantly higher in the PD group (73 versus 46% in HD group, P < 0.01). The population was stratified to PD and HD comparing mortality, infection, bacteraemia and hospitalization.
Of the 123 patients who commenced acute and unplanned dialysis, n = 44 (35.8%) died during the follow-up period of 0-183 days. There were no significant difference in half-year mortality in n = 20 PD patients (30.3%) versus n = 24 HD patients (42.1%) (P = 0.19). The cardiovascular mortality in PD and HD patients were 9.1 and 10.5%, respectively (P = 1.00). Overall mortality due to infection was higher in the HD (17.5%) versus in the PD group (9.1%), however, not significant (P = 0.19). HD patients had significantly higher probability of bacteraemia in the first 183 days compared to PD patients (21.1 versus 3.0%, P < 0.01). Group comparison by Poisson regression analyses showed that the relative risk of bacteraemia in the PD group versus HD group was 0.16 (95% confidence interval, 0.05-0.57, P = 0.005). The significant difference was not affected by the confounder's patient age at time of dialysis, male sex, heart failure (NYHA III-IV), diabetes, malignancy and peripheral arterial occlusive disease Stage IV. There were high proportions of hospitalization after the initiation of dialysis in both groups (PD 75.0% and HD 67.3%, P = 0.40). Univariate and multiple regression analyses revealed only age at initiation of dialysis to be significantly associated with overall mortality (P < 0.05).
Dialysis modality (PD versus HD) in an acute unplanned dialysis setting showed, in our population, no significant influence on survival. HD patients had a significantly higher risk of bacteraemia, perhaps due to central venous dialysis catheter. PD seems to be a safe and efficient, at least comparable, alternative to HD in acute unplanned dialysis settings.
在非计划性急性透析开始时，透析方式（血液透析或腹膜透析）对结局的影响，尤其是对感染的影响，尚未得到很好的评估。本研究旨在比较计划性急性腹膜透析（PD）或血液透析（HD）起始的透析患者的死亡率和发病率的发生率和原因。
在这项观察性队列研究中，2005 年 3 月至 2010 年 6 月在单一中心开始非计划性急性 PD（n = 66）或 HD（n = 57）的透析患者被纳入并随访 6 个月（0-183 天，平均随访时间 4.72 个月）。对于 PD，使用手术放置的 Tenckhoff 导管。所有 HD 患者均使用中央静脉导管（非隧道或隧道）进行透析。两组在性别、年龄和糖尿病患病率方面无显著差异。PD 组心力衰竭（纽约心脏协会[NYHA]III-IV 期）的患病率明显更高（73%比 HD 组的 46%，P < 0.01）。PD 和 HD 患者在死亡率、感染、菌血症和住院方面进行分层比较。
在开始急性和非计划性透析的 123 例患者中，44 例（35.8%）在 0-183 天的随访期间死亡。20 例 PD 患者（30.3%）和 24 例 HD 患者（42.1%）在半年死亡率方面无显著差异（P = 0.19）。PD 和 HD 患者的心血管死亡率分别为 9.1%和 10.5%（P = 1.00）。HD 患者的总感染死亡率明显高于 PD 组（17.5%比 9.1%），但无统计学意义（P = 0.19）。HD 患者在最初 183 天内发生菌血症的可能性明显高于 PD 患者（21.1%比 3.0%，P < 0.01）。PD 组与 HD 组的泊松回归分析显示，PD 组菌血症的相对风险为 0.16（95%置信区间，0.05-0.57，P = 0.005）。混杂因素如透析时患者年龄、男性、心力衰竭（NYHA III-IV）、糖尿病、恶性肿瘤和外周动脉闭塞性疾病 IV 期，并未影响这一显著差异。两组患者在开始透析后均有较高比例的住院治疗（PD 组 75.0%，HD 组 67.3%，P = 0.40）。单因素和多因素回归分析显示，只有透析开始时的年龄与总死亡率显著相关（P < 0.05）。
在非计划性急性透析中，透析方式（PD 与 HD）在我们的人群中对生存率没有显著影响。HD 患者菌血症的风险明显更高，这可能是由于中央静脉透析导管所致。PD 似乎是急性非计划性透析的一种安全有效的替代方案，至少与 HD 一样有效。
