Clinical Research Center for End-Stage Renal Disease (CRC for ESRD) in Korea.
School of Medicine, Kyungpook National University, Daegu, Korea.
PLoS One. 2018 Apr 25;13(4):e0196294. doi: 10.1371/journal.pone.0196294. eCollection 2018.
Prevalent anuric peritoneal dialysis (PD) patients usually have higher mortality than PD patients with residual urine volume. We aimed to evaluate the predictors of survival in anuric PD patients. Anuric PD patients (n = 505, <100 mL of daily urine) enrolled in Korean nationwide prospective cohort were analyzed. Survived and non-survived anuric PD patients were compared by propensity score matching analysis with a ratio of two to one. The propensity method was used to adjust for patient age, dialysis duration, and presence of diabetes. Among the total anuric PD patients, non-survived patients showed a significantly older age, higher incidence of diabetes, coronary artery disease, and arrhythmia, and lower serum creatinine and albumin. After propensity score matching, multivariate Cox regression analysis for patient survival showed a decreasing risk as serum albumin increased (HR = 0.347, p = 0.0094). Analysis using the receiver-operating-characteristic (ROC) curve showed that survival could be predicted with a sensitivity of 59.4% and a specificity of 63.2% using a cutoff value of 3.6 g/dL of serum albumin in unmatched total PD patients. The beneficial impact of high albumin level on death was significantly greater for patients with older age (≥50 years), no diabetes, low ultrafiltration (UF) volume (<1000 mL/day), and low levels of serum creatinine (<10 mg/dL), total cholesterol (<177.5 mg/dL), ferritin (<100 ng/mL), and high-sensitivity C-reactive protein (hs-CRP) (<0.1 mg/dL). Survival in anuric PD patients was associated with age, comorbidities, and nutritional factors such as creatinine and albumin. After adjustment by propensity score matching, serum albumin level was an independent predictor for survival in anuric PD patients.
无尿的持续性不卧床腹膜透析（PD）患者的死亡率通常高于有残余尿量的 PD 患者。我们旨在评估无尿 PD 患者的生存预测因素。对韩国全国前瞻性队列中纳入的 505 例无尿 PD 患者（每日尿量＜100ml）进行分析。通过倾向评分匹配分析，以 2:1 的比例比较存活和非存活的无尿 PD 患者。采用倾向评分法调整患者年龄、透析时间和糖尿病的存在。在所有无尿 PD 患者中，非存活患者的年龄较大，糖尿病、冠心病和心律失常的发生率较高，血清肌酐和白蛋白较低。经过倾向评分匹配后，多变量 Cox 回归分析显示，随着血清白蛋白的增加，患者的生存风险呈下降趋势（HR=0.347，p=0.0094）。使用受试者工作特征（ROC）曲线分析表明，在未匹配的总 PD 患者中，使用 3.6g/dL 的血清白蛋白截断值，生存可以预测，灵敏度为 59.4%，特异性为 63.2%。在年龄较大（≥50 岁）、无糖尿病、超滤量较低（＜1000ml/天）、血清肌酐水平较低（＜10mg/dL）、总胆固醇水平较低（＜177.5mg/dL）、铁蛋白水平较低（＜100ng/ml）和高敏 C 反应蛋白（hs-CRP）水平较低（＜0.1mg/dL）的患者中，高白蛋白水平对死亡的有益影响显著更大。无尿 PD 患者的生存与年龄、合并症以及肌酐和白蛋白等营养因素有关。经过倾向评分匹配调整后，血清白蛋白水平是无尿 PD 患者生存的独立预测因素。
