Díaz Cuevas María, Limón Ramírez Ramón, Pérez Contreras Francisco Javier, Gómez Roldán Carmen
Servicio de Nefrología, Hospital General Universitario de Alicante, Alicante, Spain.
Subdirección General de Evaluación de la Gestión Asistencial, Dirección General de Asistencia Sanitaria, Conselleria de Sanitat Universal i Salut Pública, Valencia, Spain.
Nefrologia (Engl Ed). 2021 Jan-Feb;41(1):53-61. doi: 10.1016/j.nefroe.2020.05.005. Epub 2021 Mar 3.
Glomerulonephritis (GN) is one of the main causes of chronic terminal kidney disease; however, few studies assess its prognosis in dialysis. We analyze the survival and characteristics of patients on peritoneal dialysis (PD) with primary GN (PGN), and compare their results with other kidney patients.
This prospective observational study took place from 1995 to 2014. We included all incident patients who were initiated on the technique in the Levante registry. Data were transferred to an anonymized database in Access. Statistical analysis was performed using SPSS software (version 19.0).
The study included 2243 patients, with GN representing the main cause of primary kidney disease (21,5%). IgA nephropathy was the most frequent histologically confirmed form of PGN. Compared with the rest of the sample, patients with PGN were more often men (65% vs 58%, p = .004), and they were on average younger (48 years vs 55 years, p < .001). They also had fewer comorbidities and a higher rate of inclusion on the waitlist for a kidney transplant (87 vs 63%, p < .001). Patients with PGN also had more transplants (48,9%, p < .001), and this was the most frequent reason for stopping PD; beyond that, their peritonitis mean rate was lower (0,34 vs 0,45 episodes/patient-year, p < .001). Technique survival was 90,6% at one year, 71,7% at 3 years, and 59,0% at 5 years (median 76,8 months); there were no differences between groups. Survival was 94,9% at one year, 80,1% at 3 years, and 63,7% at 5 years (median 90,7 months). Patients with PGN showed better mean survival than patients with other kidney pathologies (153,5 months [95% IC: 137,0-169,9] vs 110,3 months [95% CI: 100,8-119,7], p < .001). In the multivariable analysis, the main negative risk factor influencing technique survival was a higher peritoneal transport (p = .018). Factors with a negative influence on mortality were being older (p < .001) and having any comorbidity, mainly diabetes and liver disease (p < .001). By contrast, protective survival factors were inclusion on the transplant waitlist and a higher baseline residual renal function (p = .001).
PD has several advantages as a first dialytic treatment, and our results suggest that it is an excellent technique to manage patients with PGN while they await a kidney transplant.
肾小球肾炎（GN）是慢性终末期肾病的主要病因之一；然而，很少有研究评估其在透析患者中的预后情况。我们分析了原发性肾小球肾炎（PGN）患者腹膜透析（PD）的生存情况及特征，并将其结果与其他肾病患者进行比较。
这项前瞻性观察性研究于1995年至2014年进行。我们纳入了莱万特登记处所有开始采用该技术的新发病例患者。数据被转移至Access中的一个匿名数据库。使用SPSS软件（版本19.0）进行统计分析。
该研究纳入了2243例患者，GN是原发性肾病的主要病因（21.5%）。IgA肾病是组织学确诊的PGN最常见类型。与样本中的其他患者相比，PGN患者男性更多（65%对58%，p = 0.004），且平均年龄更小（48岁对55岁，p < 0.001）。他们的合并症也更少，进入肾脏移植等待名单的比例更高（87%对63%，p < 0.001）。PGN患者的移植率也更高（48.9%，p < 0.001），这是停止PD最常见的原因；除此之外，他们的腹膜炎平均发生率更低（0.34对0.45次/患者年，p < 0.001）。技术生存率1年时为90.6%，3年时为71.7%，5年时为59.0%（中位数76.8个月）；各亚组间无差异。总生存率1年时为94.9%，3年时为80.1%，5年时为63.7%（中位数90.7个月）。PGN患者的平均生存情况优于其他肾病患者（153.5个月[95%可信区间：137.0 - 169.9]对110.3个月[95%可信区间：100.8 - 119.7]，p < 0.001）。在多变量分析中，影响技术生存的主要负面风险因素是腹膜转运率较高（p = 0.018）。对死亡率有负面影响的因素包括年龄较大（p < 0.001）以及患有任何合并症，主要是糖尿病和肝病（p < 0.001）。相比之下，生存保护因素是进入移植等待名单以及更高的基线残余肾功能（p = 0.001）。
PD作为首次透析治疗有多个优势，我们的结果表明这是在等待肾脏移植期间管理PGN患者的一项出色技术。
