Lan Patrick G, Clayton Philip A, Saunders John, Polkinghorne Kevan R, Snelling Paul L
Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, Australia.
Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, Australia Australia and New Zealand Dialysis and Transplantation (ANZDATA) Registry, Adelaide, Australia School of Public Health, University of Sydney, Sydney, Australia.
Perit Dial Int. 2015 May-Jun;35(3):306-15. doi: 10.3747/pdi.2013.00030. Epub 2014 Feb 4.
Peritoneal dialysis (PD) patients are commonly required to transfer to hemodialysis (HD), however the literature describing the outcomes of such transfers is limited. The aim of our study was to describe the predictors of these transfers and their outcomes according to vascular access at the time of transfer.
A retrospective cohort study using registry data of all adult patients commencing PD as their initial renal replacement therapy in Australia or New Zealand between 2004 - 2010 was performed. Follow-up was until 31 December 2010. Logistic regression models were constructed to determine possible predictors of transfer within both 6 and 12 months of PD commencement. Cox analysis and competing risks regression were used to determine the predictors of survival and transplantation post-transfer.
The analysis included 4,781 incident PD patients, of whom 1,699 transferred to HD during the study period. Logistic models did not identify any clinically useful predictors of transfer within 6 or 12 months (c-statistics 0.54 and 0.55 respectively). 67% of patients commenced HD with a central venous catheter (CVC). CVC use at transfer was associated with increased mortality (hazard ratio 1.37, 95% confidence interval (CI) 1.11 - 1.68, p = 0.003) and a borderline significant reduction in the incidence of transplantation (subhazard ratio 0.76, 95% CI 0.58 - 1.00, p = 0.05).
It is difficult to predict the transfer to HD for incident PD patients. PD patients who commence HD with a CVC have a higher risk of mortality and a lower likelihood of undergoing renal transplantation.
腹膜透析（PD）患者通常需要转为血液透析（HD），然而描述此类转换结局的文献有限。我们研究的目的是根据转换时的血管通路描述这些转换的预测因素及其结局。
采用回顾性队列研究，使用2004年至2010年期间在澳大利亚或新西兰开始将PD作为初始肾脏替代治疗的所有成年患者的登记数据。随访至2010年12月31日。构建逻辑回归模型以确定PD开始后6个月和12个月内转换的可能预测因素。使用Cox分析和竞争风险回归来确定转换后生存和移植的预测因素。
分析包括4781例新发PD患者，其中1699例在研究期间转为HD。逻辑模型未识别出6个月或12个月内转换的任何临床有用预测因素（c统计量分别为0.54和0.55）。67%的患者开始HD时使用中心静脉导管（CVC）。转换时使用CVC与死亡率增加相关（风险比1.37，95%置信区间（CI）1.11 - 1.68，p = 0.003），移植发生率有边缘性显著降低（亚风险比0.76，95%CI 0.58 - 1.00，p = 0.05）。
对于新发PD患者，很难预测其转为HD。开始HD时使用CVC的PD患者有更高的死亡风险和更低的接受肾移植可能性。
