He Zhiren, Liang Hui, Huang Jing, Zhang Defei, Ma Hongyan, Lin Junjie, Cai Youqing, Liu Tonghuan, Li Hucai, Qiu Weizhong, Wang Lingzheng, Yuan Fengling, Hou Haijing, Zhao Daixin, Liu Xusheng, Wang Lixin
Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
Front Med (Lausanne). 2022 Oct 17;9:898650. doi: 10.3389/fmed.2022.898650. eCollection 2022.
Heart failure is one of the common complications in patients with end-stage renal disease (ESRD) and a major cause of death in these patients. The choice of dialysis modality for ESRD patients with congestive heart failure (CHF) is still inconclusive. The purpose of this study was to compare the prognosis of hemodialysis (HD) and peritoneal dialysis (PD) among ESRD patients with CHF and provide a basis for clinical decision-making.
This was a retrospective study conducted at Guangdong Provincial Hospital of Traditional Chinese Medicine that included patients with CHF requiring long-term renal replacement therapy between January 1, 2012 and December 31, 2017. The end of follow-up was December 31, 2020. All patients were divided into HD and PD groups and sub grouped by age, and we used univariate and multifactorial Cox regression analyses to calculate the relative hazard ratios (HR) of the different dialysis types and adjusted for differences in baseline data using propensity score matching (PSM).
A total of 121 patients with PD and 156 patients with HD were included in this study. Among younger ESRD patients (≤65 years of age) with CHF, the prognosis of HD was worse than that of PD [HR = 1.84, 95% confidence interval (CI) = 1.01-3.34], and this disadvantage remained significant in the fully adjusted model [sex, age at dialysis initiation, Charlson comorbidities index, body mass index, prealbumin, hemoglobin, and left ventricular ejection fraction (LVEF)] and after PSM. In the older group (>65 years of age), the prognosis of HD was better than that of PD (HR = 0.46, 95% CI = 0.25-0.85), and the protective effect remained in the fully adjusted model and after PSM. The aforementioned survival differences across the cohort were maintained in patients with preserved LVEF (>55%), but could not be reproduced in patients with reduced LVEF (≤55%).
In southern China, PD is a better choice for younger patients with ESRD, CHF and preserved LVEF, and HD is the better option for older patients.
心力衰竭是终末期肾病（ESRD）患者的常见并发症之一，也是这些患者死亡的主要原因。对于合并充血性心力衰竭（CHF）的ESRD患者，透析方式的选择仍无定论。本研究旨在比较CHF合并ESRD患者血液透析（HD）和腹膜透析（PD）的预后，并为临床决策提供依据。
这是一项在广东省中医院进行的回顾性研究，纳入了2012年1月1日至2017年12月31日期间需要长期肾脏替代治疗的CHF患者。随访截止于2020年12月31日。所有患者分为HD组和PD组，并按年龄分组，我们采用单因素和多因素Cox回归分析计算不同透析类型的相对风险比（HR），并使用倾向评分匹配（PSM）对基线数据差异进行校正。
本研究共纳入121例PD患者和156例HD患者。在年龄较小（≤65岁）的CHF合并ESRD患者中，HD的预后比PD差[HR = 1.84，95%置信区间（CI）= 1.01 - 3.34]，在完全校正模型[性别、开始透析时的年龄、Charlson合并症指数、体重指数、前白蛋白、血红蛋白和左心室射血分数（LVEF）]以及PSM后，这种劣势仍然显著。在年龄较大（>65岁）的组中，HD的预后比PD好（HR = 0.46，95% CI = 0.25 - 0.85），并且在完全校正模型和PSM后，保护作用仍然存在。上述队列中的生存差异在LVEF保留（>55%）的患者中得以维持，但在LVEF降低（≤55%）的患者中未重现。
在中国南方，对于年龄较小、合并CHF且LVEF保留的ESRD患者，PD是更好的选择，而对于年龄较大的患者，HD是更好的选择。
