196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, People's Republic of China.
Perit Dial Int. 2020 Nov;40(6):573-580. doi: 10.1177/0896860820927534. Epub 2020 Jun 3.
Few studies evaluated over 5-year outcomes of dialysis patients. This study examined 10-year all-cause mortality and death-censored technique failure in a cohort of incident peritoneal dialysis (PD) individuals.
Five hundred and thirty-three incident PD individuals from 2006 to 2008 were prospectively followed up for more than 10 years until 2018. Clinical characteristics at PD initiation were collected. The primary outcome was all-cause mortality, and the secondary outcome was death-censored technique failure. Cox hazards models were fit using clinical characteristics at PD initiation.
The mean age starting PD for these participants was 48 ± 16 years; 130 (24%) patients had diabetic nephropathy. During follow-up, 208 patients died, and 84 patients experienced technique failures. The 1, 3, 5, and 10 years' survival rates for incident PD patients were 93%, 81%, 64%, and 36%, respectively, and the technical survival rates were 98%, 93%, 85%, and 62%, respectively. Mortality risk was much higher after 3 years on PD. The peritonitis rate was 0.19 episodes per patient-year, and 7 (1.3%) patients had encapsulating peritoneal sclerosis (EPS) giving an incidence rate of 3.1 of 1000 patient-years. The main causes of death were cardiovascular events (97 of 208, 47%), and technique failure was mainly due to peritonitis (41 of 84, 49%). Older age, higher Charlson comorbidity index, and lower level of education were strongly associated with mortality, and diabetic nephropathy was an independent risk factor for technique failure.
The 10-year's survival and technique survival rates of incident PD patients were 36% and 62%. Long-term PD can be continued successfully with improved outcomes and low risk for EPS.
很少有研究评估透析患者超过 5 年的结局。本研究检查了 2006 年至 2008 年期间开始腹膜透析（PD）的患者队列中 10 年全因死亡率和死亡校正技术失败。
2006 年至 2008 年期间前瞻性随访了 533 例开始 PD 的患者，随访时间超过 10 年，直至 2018 年。收集 PD 开始时的临床特征。主要结局是全因死亡率，次要结局是死亡校正技术失败。使用 PD 开始时的临床特征拟合 Cox 风险模型。
这些参与者开始 PD 的平均年龄为 48 ± 16 岁；130 名（24%）患者患有糖尿病肾病。在随访期间，208 名患者死亡，84 名患者经历了技术失败。新开始 PD 的患者的 1、3、5 和 10 年生存率分别为 93%、81%、64%和 36%，技术生存率分别为 98%、93%、85%和 62%。PD 后 3 年死亡率风险高得多。腹膜炎发生率为 0.19 例/患者年，7 例（1.3%）患者患有包裹性腹膜硬化症（EPS），发病率为每 1000 患者年 3.1 例。死亡的主要原因是心血管事件（208 例中的 97 例，47%），技术失败主要是由于腹膜炎（84 例中的 41 例，49%）。年龄较大、Charlson 合并症指数较高和教育程度较低与死亡率密切相关，糖尿病肾病是技术失败的独立危险因素。
新开始 PD 的患者的 10 年生存率和技术生存率分别为 36%和 62%。随着结局的改善和 EPS 风险的降低，长期 PD 可以成功继续。
