Franco Marcia R G, Bastos Marcus G, Qureshi Abdul R, Schreider Alyne, Bastos Kleyton de Andrade, Divino-Filho Jose C, Fernandes Natalia M S
Department of Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
Department of Clinical Science, CLINTEC, Karolinska Institute, Stockholm, Sweden.
Saudi J Kidney Dis Transpl. 2017 Jul-Aug;28(4):782-791.
Aging of the population and the increased prevalence of diseases such as diabetes and arterial hypertension result in an increasing need of dialysis treatment. Herein we describe a cohort of elderly patients on peritoneal dialysis (PD) and assess the influence of the modality on the long-term survival. Out of a multicenter prospective cohort of 2,144 BRAZPD PD incident patients during a period from December 2004 to October 2007, 762 elderly adults, defined as patients ≥65-year-old, were eligible for the study, 413 started on automated PD (APD) and 349 on continuous ambulatory PD (CAPD). Patients were followed until death, transfer to hemodialysis, recovery of renal function, loss to follow-up, or transplantation. Demographics and clinical data were evaluated at baseline and described as mean ± standard deviation, median, or percentage. Competing risk and time-dependent Cox analysis were performed, having dialysis modality APD] vs. CAPD as a dependent variable, as hazard ratio (HR) is not proportional throughout the therapy time. Mean age was 74.5 ± 6.8 years in APD, 74.6 ± 6.7 in CAPD, 50.8% females in APD, 54.4% in CAPD. The frequently observed comorbidities were diabetes (52.3% in APD and 47% in CAPD) and left ventricular hypertrophy (36.3% in APD and 46.1% in CAPD) whereas 93.6% presented Davies score ≥2. In Cox time-dependent analysis, HR did not show difference up to 18 months HR = 1.11, confidence interval (CI) = 0.85-1.46], but thereafter, APD modality revealed lower risk of mortality (HR = 0.25, CI = 0.0073-0.86), when compared with CAPD. After adjustment for the confounding factors, CAPD presented a higher risk of mortality (HR = 4.50, CI = 1.29-15.64). No differences in survival were observed up to 18 months of therapy; however, beyond 18 months, APD modality was a protection factor.
人口老龄化以及糖尿病和动脉高血压等疾病患病率的增加导致透析治疗需求不断上升。在此，我们描述了一组接受腹膜透析（PD）的老年患者，并评估了该治疗方式对长期生存的影响。在2004年12月至2007年10月期间的一个多中心前瞻性队列研究中，共有2144例BRAZPD新发病例，其中762例老年患者（定义为年龄≥65岁）符合研究条件，413例开始接受自动化腹膜透析（APD），349例开始接受持续性非卧床腹膜透析（CAPD）。对患者进行随访直至死亡、转为血液透析、肾功能恢复、失访或移植。在基线时评估人口统计学和临床数据，并以均值±标准差、中位数或百分比表示。进行了竞争风险和时间依赖性Cox分析，将透析方式APD与CAPD作为因变量，因为风险比（HR）在整个治疗期间并非呈比例关系。APD组的平均年龄为74.5±6.8岁，CAPD组为74.6±6.7岁；APD组女性占50.8%，CAPD组占54.4%。常见合并症为糖尿病（APD组为52.3%，CAPD组为47%）和左心室肥厚（APD组为36.3%，CAPD组为46.1%），而93.6%的患者戴维斯评分≥2。在Cox时间依赖性分析中，至18个月时HR无差异（HR = 1.11，置信区间[CI]=0.85 - 1.46），但此后，与CAPD相比，APD方式显示出较低的死亡风险（HR = 0.25，CI = 0.0073 - 0.86）。在对混杂因素进行调整后.CAPD的死亡风险更高（HR = 4.50，CI = 1.29 - 15.64）。在治疗18个月内未观察到生存差异；然而，超过18个月后，APD方式是一个保护因素。
