Domenici Alessandro, Comunian Maria Cristina, Fazzari Loredana, Sivo Francesca, Dinnella Angela, Della Grotta Barbara, Punzo Giorgio, Menè Paolo
Nephrology and Dialysis Unit, Department of Cardiovascular, Renal and Pulmonary Diseases, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy.
Int J Nephrol. 2011;2011:204216. doi: 10.4061/2011/204216. Epub 2011 Sep 15.
Background. The value of incremental peritoneal dialysis (PD) as a bridge to renal transplantation (Tx) has not been specifically addressed. Methods. All consecutive Stage 5 CKD patients with at least 1 year predialysis followup, starting incremental PD or HD under our care and subsequently receiving their first renal Tx were included in this observational cohort study. Age, gender, BMI, underlying nephropathy, residual renal function (RRF) loss rate before dialysis and RRF at RRT start, comorbidity, RRT schedules and adequacy measures, dialysis-related morbidity, Tx waiting time, RRF at Tx, incidence of delayed graft function (DGF), in-hospital stay for Tx, serum creatinine at discharge and one year later were collected and compared between patients on incremental PD or HD before Tx. Results. Seventeen patients on incremental PD and 24 on HD received their first renal Tx during the study period. Age, underlying nephropathy, RRF loss rate in predialysis, RRF at the start of RRT and comorbidity did not differ significantly. While on dialysis, patients on PD had significantly lower epoetin requirements, serum phosphate, calciumxphosphate product and better RRF preservation. Delayed graft function (DGF) occurred in 12 patients (29%), 1 on incremental PD and 11 on HD. Serum creatinine at discharge and 1 year later was significantly higher in patients who had been on HD. Conclusions. In patients receiving their first renal Tx, previous incremental PD was associated with low morbidity, excellent preservation of RRF, easier attainment of adequacy targets and significantly better immediate and 1-year graft function than those observed in otherwise well-matched patients previously treated with HD.
背景。递增式腹膜透析（PD）作为肾移植（Tx）桥梁的价值尚未得到具体探讨。方法。本观察性队列研究纳入了所有在我们的照护下开始递增式PD或血液透析（HD）且至少有1年透析前随访时间、随后接受首次肾移植的连续性5期慢性肾脏病（CKD）患者。收集并比较了肾移植前接受递增式PD或HD治疗的患者的年龄、性别、体重指数、潜在肾病、透析前残余肾功能（RRF）损失率和开始肾脏替代治疗（RRT）时的RRF、合并症、RRT方案和充分性指标、透析相关发病率、肾移植等待时间、肾移植时的RRF、移植肾功能延迟恢复（DGF）的发生率、肾移植住院时间、出院时和1年后的血清肌酐。结果。在研究期间，17例接受递增式PD治疗的患者和24例接受HD治疗的患者接受了首次肾移植。年龄、潜在肾病、透析前RRF损失率、RRT开始时的RRF和合并症无显著差异。在透析期间，接受PD治疗的患者促红细胞生成素需求量、血清磷酸盐、钙磷乘积显著更低，RRF保存更好。12例患者（29%）发生了移植肾功能延迟恢复，其中1例接受递增式PD治疗，11例接受HD治疗。接受HD治疗的患者出院时和1年后的血清肌酐显著更高。结论。在接受首次肾移植的患者中，与其他情况匹配但先前接受HD治疗的患者相比，先前接受递增式PD治疗的患者发病率低、RRF保存良好、更容易达到充分性目标，并且移植后即刻和1年时的移植肾功能显著更好。
