Lu Yueh-An, Tu Kun-Hua, Lee Cheng-Chia, Wu Patricia W, Chang Chee-Jen, Tian Ya-Chung, Yang Chih-Wei, Chu Pao-Hsien
Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan.
Department of Medicine, Chang Gung University, Taoyuan, Taiwan.
PLoS One. 2017 Mar 16;12(3):e0173710. doi: 10.1371/journal.pone.0173710. eCollection 2017.
Peritonitis has been independently associated with increased morbidity and mortality in peritoneal dialysis patients. However, there are few reports on peritonitis in hemodialysis patients. We aim at investigating both the risk profiles and prognostic impact of peritonitis in hemodialysis patients.
This nation-wide longitudinal study uses claims data obtained from the Taiwan National Health Insurance Research Database. A total of 80,733 incident hemodialysis patients of age ≥ 20 years without a history of peritonitis were identified between January 1, 1998 and December 31, 2009. Predictors of peritonitis events were estimated using Cox proportional hazard models. Time-dependent Cox proportional hazard models were used to estimate hazard ratio for mortality attributed to peritonitis exposure.
Of 80,733 incident hemodialysis patients over a 13-year study period, peritonitis was diagnosed in 935 (1.16%), yielding an incidence rate of 2.91 per 1000 person-years. Female gender, liver cirrhosis and polycystic kidney disease were three of the most significant factors for peritonitis in both non-diabetic and diabetic hemodialysis patients. The cumulative survival rate of patients with peritonitis was 38.8% at 1 year and 10.1% at 5 years. A time-dependent Cox multivariate analysis showed that peritonitis had significantly increased hazard ratio for all cause mortality. Additionally, the risk of mortality remained significantly higher for non-diabetic hemodialysis patients that experienced peritonitis.
The risk of peritonitis in hemodialysis patients is higher in female gender, liver cirrhosis and polycystic kidney disease. Although peritonitis is a rare condition, it is associated with significantly poorer outcome in hemodialysis patients.
腹膜炎与腹膜透析患者发病率和死亡率的增加独立相关。然而，关于血液透析患者腹膜炎的报道较少。我们旨在调查血液透析患者腹膜炎的风险特征和预后影响。
这项全国性纵向研究使用了从台湾国民健康保险研究数据库获得的理赔数据。在1998年1月1日至2009年12月31日期间，共识别出80733例年龄≥20岁且无腹膜炎病史的新发性血液透析患者。使用Cox比例风险模型估计腹膜炎事件的预测因素。使用时间依赖性Cox比例风险模型估计因腹膜炎暴露导致的死亡风险比。
在为期13年的研究期内，80733例新发性血液透析患者中，935例（1.16%）被诊断为腹膜炎，发病率为每1000人年2.91例。女性、肝硬化和多囊肾病是非糖尿病和糖尿病血液透析患者发生腹膜炎的三个最重要因素。腹膜炎患者的1年累积生存率为38.8%，5年累积生存率为10.1%。时间依赖性Cox多变量分析表明，腹膜炎显著增加了全因死亡率的风险比。此外，发生腹膜炎的非糖尿病血液透析患者的死亡风险仍然显著更高。
女性、肝硬化和多囊肾病患者血液透析时发生腹膜炎的风险更高。虽然腹膜炎是一种罕见病症，但它与血液透析患者显著更差的预后相关。
