Matsui Masaru, Akai Yasuhiro, Samejima Ken-Ichi, Tsushima Hideo, Tanabe Kaori, Morimoto Katsuhiko, Tagawa Miho, Saito Yoshihiko
First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
Department of Regional Medicine, Nara Medical University, Kashihara, Japan.
Ther Apher Dial. 2017 Oct;21(5):493-499. doi: 10.1111/1744-9987.12546. Epub 2017 May 15.
Technique failure remains a frequent cause of peritoneal dialysis (PD) withdrawal. Many post-commencement predictors of PD technique failure have been identified, while predialysis predictors have remained unclear. The aim of this study was to identify predialysis indices for technique failure in PD patients. We recruited 206 consecutive PD patients who were treated at Nara Medical University Hospital between 1 April 1997 and 31 December 2012. Forty-eight patients were excluded because of transition from hemodialysis (HD) or withdrawal from PD within 3 months, leaving 158 patients for analysis. Clinical characteristics and laboratory data from within 3 months preceding PD commencement were analyzed. The primary outcome was the composite of time to combined use of HD, transition to HD, and all-cause mortality within 2 years after PD commencement. During the study period, the primary outcome was observed in 50 patients. Using multivariate analysis, greater age (odds ratios (ORs) [95%CI], 3.08 [1.72-5.61]), anemia (ORs [95%CI], 2.12 [1.08-4.43]), overweight/obesity (ORs [95%CI], 2.09 [1.16-3.72]), and hypocalcemia (ORs [95%CI], 1.86 [1.04-3.35]) were independently associated with technique failure. Adding corrected calcium to the model incorporating age, body mass index, and hemoglobin significantly increased the c-statistic from 0.678 to 0.755 (P = 0.048) relative to the model incorporating age alone. The integrated discrimination improvement was 0.085 (95% CI 0.036-0.134, P < 0.001) and the continuous net reclassification improvement was 0.395 (95% CI 0.066-0.724, P = 0.02). In conclusion, the combination of predialysis indices comprising age, overweight/obesity, anemia, and corrected calcium could provide a significant predictive value for technique failure of PD.
技术失败仍是腹膜透析（PD）治疗中断的常见原因。许多PD技术失败的起始后预测因素已被确定，而透析前预测因素仍不明确。本研究的目的是确定PD患者技术失败的透析前指标。我们招募了1997年4月1日至2012年12月31日期间在奈良医科大学医院接受治疗的206例连续性PD患者。48例患者因在3个月内从血液透析（HD）转换或退出PD而被排除，剩余158例患者进行分析。分析了PD开始前3个月内的临床特征和实验室数据。主要结局是PD开始后2年内HD联合使用时间、转换为HD和全因死亡率的综合情况。在研究期间，50例患者出现了主要结局。通过多因素分析，年龄较大（比值比（OR）[95%置信区间]，3.08[1.72 - 5.61]）、贫血（OR[95%置信区间]，2.12[1.08 - 4.43]）、超重/肥胖（OR[95%置信区间]，2.09[1.16 - 3.72]）和低钙血症（OR[95%置信区间]，1.86[1.04 - 3.35]）与技术失败独立相关。相对于仅纳入年龄的模型，将校正钙添加到纳入年龄、体重指数和血红蛋白的模型中，c统计量从0.678显著增加到0.755（P = 0.048）。综合判别改善为0.085（95%置信区间0.036 - 0.134，P < 0.001），连续净重新分类改善为0.395（95%置信区间0.066 - 0.724，P = 0.02）。总之，由年龄、超重/肥胖、贫血和校正钙组成的透析前指标组合可为PD技术失败提供显著的预测价值。
