Nadeau-Fredette Annie-Claire, Bargman Joanne M, Chan Christopher T
Toronto General Hospital - University Health Network, University of Toronto, Toronto, Ontario, Canada.
Perit Dial Int. 2015 May-Jun;35(3):316-23. doi: 10.3747/pdi.2013.00163. Epub 2014 Mar 1.
Home dialysis is a cost-effective modality of renal replacement therapy associated with excellent outcomes. Peritoneal dialysis (PD) is the most common home-based modality, but technique failure remains a problem. Transfer from PD to home hemodialysis (HHD) allows the patient to continue with a home-based modality, but the outcomes of patients transitioning to HHD after PD are largely unknown.
In a retrospective cohort study, including all consecutive HHD patients between January 1996 and December 2011, we evaluated the outcomes of patients with previous PD exposure compared to those without. The primary outcome was the cumulative patient and technique survival. Secondary outcomes included time to first hospitalization and hospitalization rate. Data were compared using the log-rank test and a multivariable Cox proportional hazards model.
Among our cohort of 207 consecutive HHD patients, 35 (17%) had previous exposure to PD. Median renal replacement therapy (RRT) vintage (12.3 years, interquartile range (IQR) 8.5 - 18.9 vs 0.9 years, IQR 0.2 - 7.5, p < 0.001) and Charlson comorbidity index (CCI) (4, IQR 2 - 6 vs 3, IQR 2 - 4, p = 0.044) were higher among patients with PD exposure than those without. Despite the difference in vintage, cumulative patient and technique survival was similar in the two groups, in both unadjusted (log-rank p = 0.893) and Cox adjusted models (hazard ratio (HR) 1.15, 95% confidence interval (CI) 0.51 - 2.59) for patients with PD exposure compared to those without. The time to first hospitalization was shorter in patients with previous PD exposure compared to PD-naïve patients (log-rank p = 0.021). This association was preserved in the Cox proportional model (HR 1.65, 95% CI 1.08 - 2.54).
Despite a higher burden of comorbidity, patients with previous PD exposure had similar cumulative patient and technique survival on HHD compared to those without PD exposure. Whenever possible, HHD should be considered in PD patients in need of a new dialysis modality.
家庭透析是一种具有成本效益的肾脏替代治疗方式，疗效良好。腹膜透析（PD）是最常见的家庭透析方式，但技术失败仍是一个问题。从PD转为家庭血液透析（HHD）可使患者继续采用家庭透析方式，但PD后转为HHD的患者的结局在很大程度上尚不清楚。
在一项回顾性队列研究中，纳入了1996年1月至2011年12月期间所有连续的HHD患者，我们评估了既往有PD经历的患者与无PD经历的患者的结局。主要结局是累积患者生存率和技术生存率。次要结局包括首次住院时间和住院率。使用对数秩检验和多变量Cox比例风险模型对数据进行比较。
在我们连续的207例HHD患者队列中，35例（17%）既往有PD经历。有PD经历的患者的中位肾脏替代治疗（RRT）时间（12.3年，四分位间距（IQR）8.5 - 18.9年 vs 0.9年，IQR 0.2 - 7.5年，p < 0.001）和Charlson合并症指数（CCI）（4，IQR 2 - 6 vs 3，IQR 2 - 4，p = 0.044）高于无PD经历的患者。尽管治疗时间存在差异，但两组的累积患者生存率和技术生存率相似，在未调整的（对数秩p = 0.893）和Cox调整模型中（风险比（HR）1.15，95%置信区间（CI）0.51 - 2.59），有PD经历的患者与无PD经历的患者相比。既往有PD经历的患者的首次住院时间比未接触过PD的患者短（对数秩p = 0.021）。这种关联在Cox比例模型中得以保留（HR 1.65，95% CI 1.08 - 2.54）。
尽管合并症负担较重，但既往有PD经历的患者在HHD上的累积患者生存率和技术生存率与无PD经历的患者相似。只要有可能，对于需要新的透析方式的PD患者应考虑HHD。
