Hu Susie L, Joshi Priyanka, Kaplan Mark, Lefkovitz Judy, Poenariu Andreea, Dworkin Lance D, Michaud Dominique S
Division of Kidney Disease and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
Department of Epidemiology, Brown University, Rhode Island Hospital, Providence, RI, USA.
Perit Dial Int. 2017 Jul-Aug;37(4):477-481. doi: 10.3747/pdi.2016.00211.
The survival advantage observed among peritoneal dialysis patients early on after dialysis initiation has been largely attributed to residual renal function (RRF) preservation due to higher baseline residual function and fewer comorbidities. We hypothesize that a rapid decline in RRF is associated with higher risk of anuria and mortality. In a retrospective cohort study of 581 subjects on peritoneal dialysis with longitudinal prevalent data, we assessed whether RRF change over time, in addition to baseline RRF, increased risk of mortality and anuria using Kaplan-Meier analysis and Cox proportional hazard analysis to control for known risk factors. Rapid RRF decline (≥ 0.09 decline) over a 12-month period was associated with a 2.6-fold increase in the risk of death (hazard ratio [HR] 2.60, 95% confidence interval [CI] 1.66 - 4.07, compared with < 0.09 decline) and a 2-fold increase in anuria (HR 2.06, 95% CI 1.24 - 3.42). Each quartile of increasing severity of RRF decline over a 12-month period increased risk incrementally for death (2 quartile: HR 3.04, CI 1.26 - 7.34; 3 quartile: HR 4.01, CI 1.71 - 9.83; 4 quartile HR 5.78, CI 2.10 - 15.9) and generally for anuria (quartiles with HR 5.72 - 7.21). The escalating risk of mortality and anuria was greater for those with diabetes mellitus. In conclusion, rapid decline in RRF over a 12-month period increased the risk of mortality and likewise anuria, beyond previously established risk factors for mortality and anuria. The impact on mortality and RRF preservation was particularly severe for those with diabetes mellitus.
透析开始后早期腹膜透析患者中观察到的生存优势，很大程度上归因于较高的基线残余功能和较少的合并症所带来的残余肾功能（RRF）保留。我们假设RRF的快速下降与无尿和死亡风险增加有关。在一项对581名接受腹膜透析且有纵向患病率数据的受试者进行的回顾性队列研究中，我们使用Kaplan-Meier分析和Cox比例风险分析来控制已知风险因素，评估除基线RRF外，RRF随时间的变化是否会增加死亡和无尿风险。在12个月期间RRF快速下降（下降≥0.09）与死亡风险增加2.6倍相关（风险比[HR] 2.60，95%置信区间[CI] 1.66 - 4.07，与下降<0.09相比），与无尿风险增加2倍相关（HR 2.06，95% CI 1.24 - 3.42）。在12个月期间RRF下降严重程度每增加一个四分位数，死亡风险就会逐步增加（第二四分位数：HR 3.04，CI 1.26 - 7.34；第三四分位数：HR 4.01，CI 1.71 - 9.83；第四四分位数HR 5.78，CI 2.10 - 15.9），无尿风险一般也会增加（四分位数HR为5.72 - 7.21）。糖尿病患者的死亡和无尿风险上升幅度更大。总之，在12个月期间RRF快速下降会增加死亡风险以及同样增加无尿风险，超出了先前确定的死亡和无尿风险因素。对死亡率和RRF保留的影响对糖尿病患者尤为严重。
