Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Nephrology Division, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China.
Ren Fail. 2020 Nov;42(1):305-313. doi: 10.1080/0886022X.2020.1743310.
Early-start peritoneal dialysis (PD) is an effective option for patients need unplanned dialysis. However, there are few studies on the long-term prognosis of early-start PD patients. In this retrospective study, 635 eligible patients from 1 March 1996 to 30 September 2016 were included, and divided into three groups according to the duration of break-in period: 3 days or less, 4-13 days and more than 14 days. Patients started PD within 2 weeks and after 2 weeks were defined as early-start and conventional-start, respectively. The primary outcome was all-cause mortality, and the secondary outcome measures were peritonitis free survival and technical survival. Mechanical and infectious complications in the first 180 days were also analyzed. Early-start PD patients were more likely to have higher serum total carbon dioxide and creatinine levels and lower serum albumin, Kt/v, creatinine clearance (Ccr) and residual glomerular filtration rate (rGFR) levels at the start of PD. The median follow-up period was 30 months (interquartile range, 13-53 months). A worse survival was observed in the early-start group than that in the conventional-start group ( < 0.001), even adjustment for the covariates (HR 1.549, 95%CI 1.104-2.173, = 0.011). In the subgroup analysis, in patients commencing PD after 2006 early-start and conventional-start PD patients had comparable survival. No differences were observed in the rate of infectious and mechanical complications, peritonitis-free survival and technique survival between early-start and conventional-start PD patients. Early-start PD could be a safe and effective strategy for patients needing unplanned dialysis initiation with the progress of technology on PD.
早期开始腹膜透析（PD）是计划外透析患者的有效选择。然而，关于早期开始 PD 患者的长期预后的研究较少。在这项回顾性研究中，纳入了 1996 年 3 月 1 日至 2016 年 9 月 30 日期间的 635 名符合条件的患者，并根据导入期的持续时间分为三组：3 天或更短、4-13 天和 14 天以上。PD 开始后 2 周内和 2 周后开始 PD 的患者分别被定义为早期开始和常规开始。主要结局是全因死亡率，次要结局是腹膜炎无生存和技术生存。还分析了前 180 天的机械和感染并发症。早期开始 PD 患者的血清总二氧化碳和肌酐水平较高，血清白蛋白、Kt/v、肌酐清除率（Ccr）和残余肾小球滤过率（rGFR）水平较低。中位随访时间为 30 个月（四分位距 13-53 个月）。与常规开始组相比，早期开始组的生存状况较差（ < 0.001），即使调整了协变量（HR 1.549，95%CI 1.104-2.173， = 0.011）。在亚组分析中，在 2006 年后开始 PD 的患者中，早期开始和常规开始 PD 患者的生存情况相当。早期开始和常规开始 PD 患者的感染和机械并发症发生率、腹膜炎无生存和技术生存无差异。随着 PD 技术的进步，早期开始 PD 可能是计划外透析开始的患者的一种安全有效的策略。
