中国老年终末期肾病患者紧急起始腹膜透析的并发症和结局：一项回顾性队列研究。
Complications and outcomes of urgent-start peritoneal dialysis in elderly patients with end-stage renal disease in China: a retrospective cohort study.
机构信息
Division of Nephrology, Kidney Institute, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Division of Nephrology, Shanghai Songjiang District Central Hospital, Shanghai, China.
出版信息
BMJ Open. 2020 Mar 23;10(3):e032849. doi: 10.1136/bmjopen-2019-032849.
OBJECTIVES
To investigate the complications and survival of elderly patients with end-stage renal disease (ESRD) who received urgent-start peritoneal dialysis (USPD) or urgent-start haemodialysis (USHD), and to explore the value of peritoneal dialysis (PD) as the emergent dialysis method for elderly patients with ESRD.
DESIGN
Retrospective cohort study.
SETTING
Two tertiary care hospitals in Shanghai, China.
PARTICIPANTS
Chinese patients (n=542) >65 years of age with estimated glomerular filtration rate ≤15 mL/min/m who received urgent-start dialysis between 1 January 2005 and 31 December 2015, and with at least 3 months of treatment. Patients who converted to other dialysis methods, regardless of the initial dialysis method, were excluded, as well as those with comorbidities that could significantly affect their dialysis outcomes.
PRIMARY AND SECONDARY OUTCOME MEASURES
Dialysis-related complications and survival were compared. Patients were followed until death, stopped PD, transfer to other dialysis centres, loss to follow-up or 31 December 2016.
RESULTS
There were 309 patients in the USPD group and 233 in the USHD group. The rate of dialysis-related complications within 30 days after catheter implantation was significantly lower in the USPD group compared with the USHD group (4.5% vs 10.7%, p=0.031). The 6-month and 1, 2 and 3-year survival rates were 95.3%, 91.4%, 86.6% and 64.8% in the USPD group, and 92.2%, 85.7%, 70.2% and 57.8% in the USHD group, respectively (p=0.023). The multivariable Cox regression analysis showed that USHD (HR=2.220, 95% CI 1.298 to 3.790; p=0.004), age (HR=1.025, 95% CI 1.013 to 1.043, p<0.001) and hypokalaemia (HR=0.678, 95% CI 0.487 to 0.970; p=0.032) were independently associated with death.
CONCLUSIONS
USPD was associated with slightly better survival compared with USHD. USPD was associated with fewer complications and better survival than USHD in elderly patients with ESRD.
目的
探讨老年终末期肾病（ESRD）患者行紧急启动腹膜透析（USPD）或紧急启动血液透析（USHD）的并发症和生存率，并探讨 PD 作为老年 ESRD 患者紧急透析方法的价值。
设计
回顾性队列研究。
地点
中国上海的两家三级保健医院。
参与者
年龄>65 岁，估算肾小球滤过率（eGFR）≤15ml/min/m，2005 年 1 月 1 日至 2015 年 12 月 31 日接受紧急启动透析，且至少接受 3 个月治疗的中国患者。排除了转为其他透析方法的患者（无论初始透析方法如何），以及存在可能显著影响其透析结局的合并症的患者。
主要和次要结局指标
比较透析相关并发症和生存率。患者随访至死亡、停止 PD、转至其他透析中心、失访或 2016 年 12 月 31 日。
结果
USPD 组 309 例，USHD 组 233 例。与 USHD 组相比，USPD 组导管植入后 30 天内透析相关并发症发生率显著降低（4.5%比 10.7%，p=0.031）。USPD 组的 6 个月和 1、2、3 年生存率分别为 95.3%、91.4%、86.6%和 64.8%，USHD 组分别为 92.2%、85.7%、70.2%和 57.8%（p=0.023）。多变量 Cox 回归分析显示，USHD（HR=2.220，95%CI 1.298 至 3.790；p=0.004）、年龄（HR=1.025，95%CI 1.013 至 1.043，p<0.001）和低钾血症（HR=0.678，95%CI 0.487 至 0.970；p=0.032）与死亡独立相关。
结论
与 USHD 相比，USPD 略有改善生存率。USPD 与 USHD 相比，老年 ESRD 患者并发症更少，生存率更高。
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