Cho Yeoungjee, Badve Sunil V, Hawley Carmel M, McDonald Stephen P, Brown Fiona G, Boudville Neil, Clayton Philip, Johnson David W
Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.
Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Department of Nephrology and Transplantation Services, University of Adelaide at the Queen Elizabeth Hospital, Adelaide, Australia.
Nephrol Dial Transplant. 2014 Oct;29(10):1940-7. doi: 10.1093/ndt/gfu050. Epub 2014 Mar 3.
There has not been a comprehensive examination to date of peritoneal dialysis (PD) outcomes after temporary haemodialysis (HD) transfer for peritonitis.
The study included all incident Australian patients who experienced peritonitis between 1 October 2003, and 31 December 2011, using Australia and New Zealand Dialysis and Transplant Registry data. Patients were grouped into three categories: Interim HD, Permanent HD and Never HD based on HD transfer status after the first peritonitis. The independent predictors of HD transfer and subsequent return to PD were determined by multivariable, multilevel mixed-effects logistic regression analysis. Matched case-control analyses were performed to compare clinical outcomes (e.g. patient survival) between groups.
Of the 3305 patients who experienced peritonitis during the study period, 553 episodes (16.7%) resulted in transfer to HD and 101 patients subsequently returned to PD. HD transfer was significantly and independently predicted by inpatient treatment of peritonitis [odds ratio (OR) 11.45, 95% confidence interval (CI) 7.14-18.36] and the recovered microbiologic profile of organisms recognized to be associated with moderate (20-40%) to high (>40%) rates of catheter removal (moderate: OR 2.45, 95% CI 1.89-3.17; high: OR 8.63, 95% CI 6.44-11.57). Matched case-control analyses yielded comparable results among Interim, Permanent and Never HD groups in terms of patient survival (P = 0.28), death-censored technique survival [hazard ratio (HR) 0.87, 95% CI 0.59-1.28; P = 0.48] and peritonitis-free survival (HR 0.84, 95% CI 0.50-1.39, P = 0.49).
In an observational registry study of first peritonitis episodes, temporary HD transfer was not associated with inferior patient-level clinical outcomes when compared with others who either never required HD transfer or remained on HD permanently if all patient-level and peritonitis-related factors were considered equal. Therefore, return to PD after a temporary HD due to peritonitis should not be discouraged in appropriate PD patients.
迄今为止，尚未对因腹膜炎而进行临时血液透析（HD）转换后的腹膜透析（PD）结局进行全面检查。
本研究纳入了2003年10月1日至2011年12月31日期间所有发生腹膜炎的澳大利亚新发病例患者，使用澳大利亚和新西兰透析与移植登记处的数据。根据首次腹膜炎后的HD转换状态，将患者分为三类：临时HD、永久HD和从未进行HD。通过多变量、多水平混合效应逻辑回归分析确定HD转换及随后恢复PD的独立预测因素。进行配对病例对照分析以比较各组之间的临床结局（如患者生存率）。
在研究期间发生腹膜炎的3305例患者中，553例（16.7%）转为HD治疗，101例患者随后恢复PD治疗。腹膜炎住院治疗[比值比（OR）11.45，95%置信区间（CI）7.14 - 18.36]以及与中等（20% - 40%）至高（>40%）导管拔除率相关的已恢复微生物谱显著且独立地预测了HD转换（中等：OR 2.45，95% CI 1.89 - 3.17；高：OR 8.63，95% CI 6.44 - 11.57）。配对病例对照分析在临时HD组、永久HD组和从未进行HD组之间得出了在患者生存率（P = 0.28）、死亡校正技术生存率[风险比（HR）0.87，95% CI 0.59 - 1.28；P = 0.48]和无腹膜炎生存率（HR 0.84，95% CI 0.50 - 1.39，P = 0.49）方面具有可比性的结果。
在一项关于首次腹膜炎发作的观察性登记研究中，如果所有患者水平和与腹膜炎相关的因素被视为相等，与那些从未需要HD转换或永久维持HD的患者相比，临时HD转换与较差的患者水平临床结局无关。因此，对于合适的PD患者，不应阻止因腹膜炎进行临时HD后恢复PD治疗。
