Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.
Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
Kidney Blood Press Res. 2024;49(1):91-99. doi: 10.1159/000535566. Epub 2023 Dec 7.
In-center automated peritoneal dialysis (APD) has been more frequently adopted in clinical practice for maintenance PD patients in China. For a better understanding of its clinical uptake, this retrospective study reviewed incident PD patients for a period of 6 years, investigating the practice pattern of in-center APD, factors associated with the use of in-center APD, and report on the patient survival compared to the nonusers of APD among hospitalized PD patients.
This was a cohort study of all incident PD patients who met the inclusion criteria from January 1, 2013 to September 30, 2018, and were followed until death, cessation of PD, loss to follow-up, or December 31, 2018. Clinical characteristics, patient outcomes, and detailed data on APD sessions were recorded. We used time-dependent Cox model to estimate the variables associated with the initiation of in-center APD, and marginal structural model through inverse probability weighting to adjust for time-varying APD use on the causal pathway to all-cause mortality.
A total of 651 subjects over 17,501 patient-months were enrolled. Of these, 633 (97.2%) PD patients were hospitalized at least once during follow-up, and 369 (56.7%) received in-center APD at a certain point, and the timing of APD use during the first 3 months, first year, and first 2 years since PD inception were 14.8%, 45.4%, and 74.8%, respectively. A total of 12,553 in-center APD sessions were recorded, where 85.9% used 4 bags of 5L-exchanges per prescription. Time-dependent Cox model showed that diabetes (hazard ratio (HR), 1.39, 95% confidence interval (CI), 1.09-1.76), urine output (HR 0.80, 95% CI: 0.70-0.92), serum albumin (HR 0.84, 95% CI: 0.72-0.99), hemoglobin (HR 0.88, 95% CI: 0.77-0.99), and Ca × P (HR 1.19, 95% CI: 1.06-1.35) were significantly associated with in-center APD use. Among all hospitalized PD patients, the estimated HR corresponding to the marginal causal effect of in-center APD use on all-cause mortality was 0.13 (95% CI: 0.05-0.31, p < 0.001). Starting APD after the first PD year was associated with a significantly lower risk of all-cause mortality (adjusted-HR 0.56, 95% CI: 0.33-0.95).
In-center APD is used intensively during the first 2 years of PD and is associated with certain clinical features. Overall, in-center APD use was associated with a lower risk of all-cause death when compared with non-use.
在中国，中心自动化腹膜透析（APD）在维持性腹膜透析患者的临床实践中被越来越多地采用。为了更好地了解其临床应用情况，本回顾性研究对 6 年来的腹膜透析患者进行了调查，研究了中心 APD 的应用模式、与中心 APD 使用相关的因素，并报告了与住院腹膜透析患者中未使用 APD 患者相比的患者生存率。
这是一项队列研究，纳入了所有符合纳入标准的 2013 年 1 月 1 日至 2018 年 9 月 30 日期间开始腹膜透析的患者，并随访至死亡、停止腹膜透析、失访或 2018 年 12 月 31 日。记录临床特征、患者结局和 APD 治疗的详细数据。我们使用时间依赖性 Cox 模型估计与开始中心 APD 相关的变量，并通过逆概率加权法（inverse probability weighting）在因果途径上调整时间依赖性 APD 使用对全因死亡率的影响。
共纳入了 651 名患者，共 17501 个患者月。其中，633 名（97.2%）腹膜透析患者在随访期间至少住院一次，369 名（56.7%）在某个时间点接受了中心 APD，APD 在腹膜透析开始后的前 3 个月、第 1 年和第 2 年的使用比例分别为 14.8%、45.4%和 74.8%。共记录了 12553 次中心 APD 治疗，其中 85.9%的患者每次使用 4 袋 5L 交换液。时间依赖性 Cox 模型显示，糖尿病（风险比（HR），1.39，95%置信区间（CI），1.09-1.76）、尿量（HR 0.80，95% CI：0.70-0.92）、血清白蛋白（HR 0.84，95% CI：0.72-0.99）、血红蛋白（HR 0.88，95% CI：0.77-0.99）和 Ca×P（HR 1.19，95% CI：1.06-1.35）与中心 APD 使用显著相关。在所有住院腹膜透析患者中，中心 APD 使用对全因死亡率的边际因果效应的估计 HR 为 0.13（95% CI：0.05-0.31，p < 0.001）。腹膜透析开始后第 1 年开始使用 APD 与全因死亡率显著降低相关（调整 HR 0.56，95% CI：0.33-0.95）。
中心 APD 在腹膜透析的前 2 年中被广泛应用，并与某些临床特征相关。总体而言，与未使用者相比，中心 APD 使用者的全因死亡风险较低。
