Institute for Applied Clinical Sciences, Keele University, Staffordshire, UK.
Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK.
Nephrol Dial Transplant. 2019 Sep 1;34(9):1585-1591. doi: 10.1093/ndt/gfz034.
Risk of encapsulating peritoneal sclerosis (EPS) is strongly associated with the duration of peritoneal dialysis (PD), such that patients who have been on PD for some time may consider elective transfer to haemodialysis to mitigate the risk of EPS. There is a need to determine this risk to better inform clinical decision making, but previous studies have not allowed for the competing risk of death.
This study included new adult PD patients in Australia and New Zealand (ANZ; 1990-2010) or Scotland (2000-08) followed until 2012. Age, time on PD, primary renal disease, gender, data set and diabetic status were evaluated as predictors at the start of PD, then at 3 and 5 years after starting PD using flexible parametric competing risks models.
In 17 396 patients (16 162 ANZ, 1234 Scotland), EPS was observed in 99 (0.57%) patients, less frequently in ANZ patients (n = 65; 0.4%) than in Scottish patients (n = 34; 2.8%). The estimated risk of EPS was much lower when the competing risk of death was taken into account (1 Kaplan-Meier = 0.0126, cumulative incidence function = 0.0054). Strong predictors of EPS included age, primary renal disease and time on PD. The risk of EPS was reasonably discriminated at the start of PD (C-statistic = 0.74-0.79) and this improved at 3 and 5 years after starting PD (C-statistic = 0.81-0.92).
EPS risk estimates are lower when calculated using competing risk of death analyses. A patient's estimated risk of EPS is country-specific and can be predicted using age, primary renal disease and duration of PD.
包裹性腹膜硬化症（EPS）的风险与腹膜透析（PD）的持续时间密切相关，因此已经接受 PD 一段时间的患者可能会考虑择期转为血液透析，以降低 EPS 的风险。需要确定这种风险，以便更好地为临床决策提供信息，但以前的研究没有考虑到死亡的竞争风险。
本研究纳入了澳大利亚和新西兰（ANZ；1990-2010 年）或苏格兰（2000-08 年）的新成年 PD 患者，随访至 2012 年。在开始 PD 时、开始 PD 后 3 年和 5 年评估年龄、PD 持续时间、原发肾脏疾病、性别、数据集和糖尿病状态作为预测因素，使用灵活参数竞争风险模型进行分析。
在 17396 名患者（16162 名 ANZ 患者，1234 名苏格兰患者）中，有 99 名（0.57%）患者发生了 EPS，ANZ 患者（65 名，0.4%）的发生率低于苏格兰患者（34 名，2.8%）。当考虑到死亡的竞争风险时，EPS 的估计风险要低得多（1 个 Kaplan-Meier = 0.0126，累积发生率函数 = 0.0054）。EPS 的强烈预测因素包括年龄、原发肾脏疾病和 PD 持续时间。在开始 PD 时，EPS 的风险具有较好的区分能力（C 统计量 = 0.74-0.79），并且在开始 PD 后 3 年和 5 年时有所提高（C 统计量 = 0.81-0.92）。
使用竞争风险分析计算 EPS 风险估计值较低。患者发生 EPS 的风险具有国家特异性，可以通过年龄、原发肾脏疾病和 PD 持续时间进行预测。
