Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan,
Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan.
Blood Purif. 2020;49(3):302-309. doi: 10.1159/000504040. Epub 2019 Dec 18.
In patients with end-stage kidney disease (ESKD), cardiovascular diseases (CVDs) are the most common causes of hospitalization and death.
We aimed to determine the association between dialysis modality and CVDs.
This retrospective observational cohort study compared the emergency hospitalization and mortality of patients with CVDs who underwent peritoneal dialysis (PD) versus hemodialysis (HD). After propensity score matching, the risk factors were evaluated using Cox proportional hazards regression models.
A total of 260 patients were matched: 130 of 135 PD (75 men; age, 65.4 years; dialysis vintage, 3.3 years) and 130 of 706 HD (70 men [p = 0.5]; 66.6 years [p = 0.4]; dialysis vintage, 3.1 years [p = 0.5]) patients. Emergency hospitalization rates (hospitalizations/person-years) for overall CVDs (0.138 vs. 0.066, p = 0.002) and pulmonary edema (0.048 vs. 0.019, p = 0.03) were significantly higher in patients who underwent PD than those who underwent HD. The log-rank test revealed that all-cause and CVD mortalities were significantly higher in PD (both p < 0.001). Mortality rates (deaths/person-years) for overall CVDs (0.058 vs. 0.015, p < 0.002), cerebrovascular disease (0.019 vs. 0.004, p = 0.03), and ischemic heart disease (0.010 vs. 0, p = 0.02) were significantly higher in PD. The Cox proportional hazards regression model showed that PD and age were significant predictors of emergency hospitalization (hazard ratio [HR] 2.70; 95% CI 1.53-4.77; p = 0.001) and mortality (HR 4.41; 95% CI 1.66-11.72; p = 0.003) for CVDs.
PD is a risk factor for emergency hospitalization and mortality associated with CVDs in dialysis patients with ESKD. Strict control of body fluid balance may prevent cardiovascular events in patients undergoing PD.
在终末期肾病（ESKD）患者中，心血管疾病（CVDs）是住院和死亡的最常见原因。
我们旨在确定透析方式与 CVDs 之间的关联。
本回顾性观察队列研究比较了接受腹膜透析（PD）与血液透析（HD）的 CVDs 患者的急诊住院和死亡率。在进行倾向评分匹配后，使用 Cox 比例风险回归模型评估危险因素。
共匹配了 260 名患者：135 名 PD 中的 130 名（75 名男性；年龄 65.4 岁；透析时间 3.3 年）和 706 名 HD 中的 130 名（70 名男性[P=0.5]；66.6 岁[P=0.4]；透析时间 3.1 年[P=0.5]）。总体 CVDs（每患者人年住院率）的急诊住院率（住院人数/人年）在 PD 患者中明显高于 HD 患者（0.138 比 0.066，P=0.002），肺水肿的急诊住院率（0.048 比 0.019，P=0.03）。对数秩检验显示，PD 患者的全因和 CVD 死亡率均明显高于 HD 患者（均 P<0.001）。总体 CVDs（死亡率/人年）、脑血管疾病（0.019 比 0.004，P=0.03）和缺血性心脏病（0.010 比 0，P=0.02）的死亡率在 PD 患者中明显更高。Cox 比例风险回归模型显示，PD 和年龄是 CVDs 急诊住院（危险比[HR]2.70；95%置信区间[CI]1.53-4.77；P=0.001）和死亡率（HR 4.41；95%CI 1.66-11.72；P=0.003）的显著预测因素。
PD 是 ESKD 透析患者与 CVDs 相关的急诊住院和死亡率的危险因素。严格控制体液平衡可能预防 PD 患者的心血管事件。
