Ponce Daniela, Buffarah Marina Berbel, Goes Cassiana, Balbi André
University São Paulo State- UNESP, Distrito de Rubiao Junior, Botucatu, Sao Paulo, Brazil.
PLoS One. 2015 May 12;10(5):e0126436. doi: 10.1371/journal.pone.0126436. eCollection 2015.
Peritoneal dialysis (PD) should be considered a suitable method of renal replacement therapy in acute kidney injury (AKI) patients. This study is the largest cohort providing patient characteristics, clinical practice, patterns and their relationship to outcomes in a developing country. Its objective was to describe the main determinants of patient and technique survival, including trends over time of PD treatment in AKI patients. This was a Brazilian prospective cohort study in which all adult AKI patients on PD were studied from January/2004 to January/2014. For comparison purposes, patients were divided into 2 groups according to the year of treatment: 2004-2008 and 2009-2014. Patient survival and technique failure (TF) were analyzed using the competing risk model of Fine and Gray. A total of 301 patients were included, 51 were transferred to hemodialysis (16.9%) during the study period. The main cause of TF was mechanical complication (47%) followed by peritonitis (41.2%). There was change in TF during the study period: compared to 2004-2008, patients treated at 2009-2014 had relative risk (RR) reduction of 0.86 (95% CI 0.77-0.96) and three independent risk factors were identified: period of treatment at 2009 and 2014, sepsis and age> 65 years. There were 180 deaths (59.8%) during the study. Death was the leading cause of dropout (77.9% of all cases) mainly by sepsis (58.3%), followed cardiovascular disease (36.1%). The overall patient survival was 41% at 30 days. Patient survival improved along study periods: compared to 2004-2008, patients treated at 2009-2014 had a RR reduction of 0.87 (95% CI 0.79-0.98). The independent risk factors for mortality were sepsis, age >70 years, ATN-ISS > 0.65 and positive fluid balance. As conclusion, we observed an improvement in patient survival and TF along the years even after correction for several confounders and using a competing risk approach.
腹膜透析（PD）应被视为急性肾损伤（AKI）患者合适的肾脏替代治疗方法。本研究是在一个发展中国家开展的最大队列研究，提供了患者特征、临床实践、模式及其与预后的关系。其目的是描述患者和技术生存的主要决定因素，包括AKI患者PD治疗随时间的趋势。这是一项巴西前瞻性队列研究，研究对象为2004年1月至2014年1月期间所有接受PD治疗的成年AKI患者。为进行比较，根据治疗年份将患者分为两组：2004 - 2008年组和2009 - 2014年组。使用Fine和Gray的竞争风险模型分析患者生存和技术失败（TF）情况。共纳入301例患者，研究期间51例转为血液透析（16.9%）。TF的主要原因是机械并发症（47%），其次是腹膜炎（41.2%）。研究期间TF有所变化：与2004 - 2008年相比，2009 - 2014年治疗的患者相对风险（RR）降低0.86（95%CI 0.77 - 0.96），并确定了三个独立风险因素：2009年和2014年的治疗时期、脓毒症和年龄>65岁。研究期间有180例死亡（59.8%）。死亡是退出研究的主要原因（占所有病例的77.9%），主要是脓毒症（58.3%），其次是心血管疾病（36.1%）。30天时总体患者生存率为41%。患者生存率随研究时期有所改善：与2004 - 2008年相比，2009 - 2014年治疗的患者RR降低0.87（95%CI 0.79 - 0.98）。死亡的独立风险因素为脓毒症、年龄>70岁、急性肾小管坏死 - 损伤严重度评分（ATN - ISS）>0.65和液体正平衡。总之，即使在校正多个混杂因素并采用竞争风险方法后，我们观察到多年来患者生存率和TF情况有所改善。
