Maiorca R, Vonesh E, Cancarini G C, Cantaluppi A, Manili L, Brunori G, Camerini C, Feller P, Strada A
Division of Nephrology, University Civili, Brescia, Italy.
Kidney Int. 1988 Oct;34(4):518-24. doi: 10.1038/ki.1988.212.
Comparisons of patient and technique survival were made for 120 CAPD and 139 HD patients undergoing dialysis between January 1981 and December 1986. Cox's proportional hazard regression model was used to compare patient and technique survival, with an adjustment for pre-treatment prognostic differences. Only the patients' first treatments were considered. The CAPD patients were 10 years older, on the average, than the HD patients and had more complicated conditions (58% with 3 or more co-existing risk factors vs. 35%). Overall patient survival between CAPD and HD did not differ (P = 0.2694). However, when adjusted for patient age, sex and other comorbid complicating conditions, CAPD patients over the age of 66 had a significantly lower risk of death than their HD counterparts (P less than 0.05). There were no differences in the adjusted patient survival for patients aged 30 to 66. Four pre-treatment prognostic factors had statistically significant adverse effects on patient survival: age, diabetes, malignancy and peripheral vascular disease. Survival of the HD technique, when unadjusted, was better than survival of CAPD (P = 0.0457). Even after adjustment for sex and age, this difference was still very nearly significant (P = 0.0656). No risk factors were found to be significantly associated with technique survival. Based on patient and technique survival, CAPD would appear to be an excellent alternative to HD and may be the preferred treatment for high risk patients over the age of 66.
对1981年1月至1986年12月期间接受透析的120例持续性非卧床腹膜透析（CAPD）患者和139例血液透析（HD）患者的患者生存率和技术生存率进行了比较。采用Cox比例风险回归模型比较患者生存率和技术生存率，并对治疗前的预后差异进行了调整。仅考虑患者的首次治疗。CAPD患者的平均年龄比HD患者大10岁，病情更复杂（58%有3种或更多并存危险因素，而HD患者为35%）。CAPD和HD患者的总体生存率无差异（P = 0.2694）。然而，在对患者年龄、性别和其他合并症进行调整后，66岁以上的CAPD患者死亡风险显著低于HD患者（P < 0.05）。30至66岁患者的调整后患者生存率无差异。四个治疗前预后因素对患者生存率有统计学显著的不利影响：年龄、糖尿病、恶性肿瘤和外周血管疾病。未经调整时，HD技术的生存率优于CAPD（P = 0.0457）。即使在对性别和年龄进行调整后，这种差异仍然非常接近显著水平（P = 0.0656）。未发现有危险因素与技术生存率显著相关。基于患者生存率和技术生存率，CAPD似乎是HD的极佳替代方案，可能是66岁以上高危患者的首选治疗方法。
