Prasad N, Patel M R, Chandra A, Rangaswamy D, Sinha A, Bhadauria D, Sharma R K, Kaul A, Gupta A
Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Dietetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Indian J Nephrol. 2017 Jul-Aug;27(4):301-306. doi: 10.4103/ijn.IJN_75_16.
The optimal time for dialysis initiation remains controversial. Studies have failed to show better outcomes with early initiation of hemodialysis; even a few had shown increased adverse outcomes including poorer survival. Few studies have examined the same in patients on peritoneal dialysis (PD). Measured glomerular filtration rate (mGFR) not creatinine-based estimated GFR is recommended as the measure of kidney function in end-stage renal disease (ESRD) patients. The objective of this observational study was to compare the outcomes of Indian patients initiated on PD with different residual renal function (RRF) as measured by 24-h urinary clearance method. A total of 352 incident patients starting on chronic ambulatory PD as the first modality of renal replacement therapy were followed prospectively. Patients were categorized into three groups as per mGFR at the initiation of PD (≤5, >5-10, and >10 ml/min/1.73 m). Patient survival and technique survival were compared among the three groups. Patients with GFR of ≤5 ml/min/1.73 m (hazard ratio [HR] - 3.42, 95% confidence interval [CI] - 1.85-6.30, = 0.000) and >5-10 ml/min/1.73 m (HR - 2.16, 95% CI - 1.26-3.71, = 0.005) had higher risk of mortality as compared to those with GFR of >10 ml/min/1.73 m. Each increment of 1 ml/min/1.73 m in baseline GFR was associated with 10% reduced risk of death (HR - 0.90, 95% CI - 0.85-0.96, = 0.002). Technique survival was poor in those with an initial mGFR of ≤5 ml/min/1.73 m as compared to other categories. RRF at the initiation was also an important factor predicting nutritional status at 1 year of follow-up. To conclude, initiation of PD at a lower baseline mGFR is associated with poorer patient and technique survival in Indian ESRD patients.
开始透析的最佳时机仍存在争议。研究未能表明早期开始血液透析会有更好的结果；甚至有一些研究显示不良后果增加，包括生存率更低。很少有研究在腹膜透析（PD）患者中对此进行研究。在终末期肾病（ESRD）患者中，建议使用实测肾小球滤过率（mGFR）而非基于肌酐的估算肾小球滤过率来衡量肾功能。这项观察性研究的目的是比较通过24小时尿清除率方法测量的具有不同残余肾功能（RRF）的接受PD治疗的印度患者的结局。共有352例开始接受慢性非卧床腹膜透析作为肾脏替代治疗的首发患者被前瞻性随访。根据开始腹膜透析时的mGFR将患者分为三组（≤5、>5-10和>10 ml/min/1.73 m²）。比较三组患者的生存率和技术生存率。与GFR>10 ml/min/1.73 m²的患者相比，GFR≤5 ml/min/1.73 m²（风险比[HR]-3.42，95%置信区间[CI]-1.85-6.30，P=0.000）和>5-10 ml/min/1.73 m²（HR-2.16，95%CI-1.26-3.71，P=0.005）的患者死亡风险更高。基线GFR每增加1 ml/min/1.73 m²，死亡风险降低10%（HR-0.90，95%CI-0.85-0.96，P=0.002）。与其他类别相比，初始mGFR≤5 ml/min/1.73 m²的患者技术生存率较差。开始透析时的残余肾功能也是预测随访1年时营养状况的重要因素。总之，在印度ESRD患者中，较低的基线mGFR开始腹膜透析与较差的患者生存率和技术生存率相关。
