Rigoni Marta, Torri Emanuele, Nollo Giandomenico, Zarantonello Diana, Laudon Alessandro, Sottini Laura, Guarrera Giovanni Maria, Brunori Giuliano
Innovazione e Ricerca Clinica in Sanità - IRCS, Fondazione Bruno Kessler, Via Sommarive, 18, 38123, Trento, Italy.
Dipartimento Salute e Solidarietà Sociale, Provincia Autonoma di Trento, Trento, Italy.
J Nephrol. 2017 Jun;30(3):441-447. doi: 10.1007/s40620-016-0366-6. Epub 2016 Nov 29.
Despite several studies reporting similar outcomes for peritoneal dialysis (PD) and hemodialysis (HD), the former is underused worldwide, with a PD prevalence of 15% in Italy. In 2008, the Unit of Nephrology and Dialysis of the Healthcare Trust of the Autonomous Province of Trento implemented a successful PD program which has increased the proportion of PD incident patients from 7 to 47%. We aimed to assess the effect of this extensive use of PD by comparing HD and PD in terms of survival and time-to-transplantation.
A total of 334 HD and 153 PD incident patients were enrolled between January 2008 and December 2014. After screening for exclusion criteria and propensity score matching, 279 HD and 132 PD patients were analyzed. Survival and time-to-transplantation were assessed by competing-risks regression models, using death and transplantation as primary and competing events.
Crude and adjusted regression models for survival revealed the absence of significant differences between HD and PD cumulative incidence functions (subhazard ratio: 1.09, p = 0.62 and 1.34, p = 0.10, respectively). Differently, crude and adjusted regression models for transplantation revealed a lower time-to-transplantation for PD versus HD patients (subhazard ratio: 2.34, p < 0.01, and 2.57, p < 0.01, respectively). The waiting time for placement in the transplant waiting list was longer in HD than PD patients (330 vs. 224 days, p < 0.01).
The extensive use of PD did not lead to any statistically significant difference in mortality. Furthermore, PD was associated with lower time to transplantation. PD may be a viable option for large-scale dialytic treatment in the advanced chronic kidney disease population.
尽管多项研究报告腹膜透析（PD）和血液透析（HD）的结局相似，但前者在全球范围内未得到充分利用，在意大利PD的患病率为15%。2008年，特伦托自治省医疗信托基金的肾脏病与透析科实施了一项成功的PD项目，使新发病的PD患者比例从7%增加到了47%。我们旨在通过比较HD和PD在生存及移植时间方面的情况，评估广泛使用PD的效果。
2008年1月至2014年12月期间，共纳入334例HD新发病患者和153例PD新发病患者。在筛查排除标准并进行倾向评分匹配后，对279例HD患者和132例PD患者进行分析。使用死亡和移植作为主要及竞争事件，通过竞争风险回归模型评估生存和移植时间。
生存的粗回归模型和校正回归模型显示，HD和PD的累积发病率函数之间无显著差异（亚风险比分别为1.09，p = 0.62和1.34，p = 0.10）。不同的是，移植的粗回归模型和校正回归模型显示，PD患者的移植时间比HD患者短（亚风险比分别为2.34，p < 0.01和2.57，p < 0.01）。HD患者进入移植等待名单的等待时间比PD患者长（330天对224天，p < 0.01）。
广泛使用PD在死亡率方面未导致任何统计学上的显著差异。此外，PD与较短的移植时间相关。对于晚期慢性肾脏病患者群体，PD可能是大规模透析治疗的一个可行选择。
