Tu Shiyan, Ye Hongjian, Xin Yangyang, Peng Yuan, Liu Ruihua, Guo Jing, Yi Chunyan, Mao Haiping, Yang Xiao
Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China.
Kidney Med. 2024 Jul 25;6(10):100882. doi: 10.1016/j.xkme.2024.100882. eCollection 2024 Oct.
RATIONALE & OBJECTIVE: The development of anuria has been linked to worse clinical outcomes in patients undergoing peritoneal dialysis (PD). Our objective was to investigate the incidence, risk factors, and associated clinical outcomes of anuria within the first year after starting PD.
Retrospective cohort study.
SETTING & PARTICIPANTS: Patients who started continuous ambulatory peritoneal dialysis at our center between 2006 and 2020 were included and followed up until January 31, 2023.
Age, sex, diabetes, temporary hemodialysis, angiotensin-converting enzyme inhibitors (ACEis) or angiotensin II receptor blockers (ARBs), diuretics, baseline urine volume, serum albumin, daily glucose exposure, peritonitis, and incremental PD.
The primary outcome was early anuria, defined as 24-hour urine volume ≤100 mL within the first year of PD initiation. Secondary outcomes included all-cause mortality, cardiovascular disease mortality, technique failure, and peritonitis.
Cox proportional hazards model.
A total of 2,592 patients undergoing continuous ambulatory peritoneal dialysis aged 46.7 ± 14.9 years were recruited. Among them, 58.9% were male, and 24.0% had diabetes. Within the first year of PD therapy, 159 (6.13%) patients developed anuria, with a median duration of 7.53 (interquartile range, 3.93-10.0) months. Higher baseline urine volume (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.90-0.97), higher serum albumin (HR, 0.92; 95% CI, 0.88-0.95), having diabetes before PD (HR, 0.57; 95% CI, 0.35-0.92), and prescribed incremental PD (HR, 0.27; 95% CI, 0.14-0.51) were associated with a reduced risk for early anuria, whereas a higher level of daily glucose exposure (HR, 1.01; 95% CI, 1.00-1.01) was identified as a risk factor for early anuria. Subgroup analyses showed that using ACEis or ARBs was linked to a lower risk of early anuria (HR, 0.25; 95% CI, 0.09-0.69) in diabetic patients. Treating early anuria as a time-dependent covariate, early anuria was associated with a higher risk for all-cause mortality (HR, 1.69; 95% CI, 1.23-2.32) and technique failure (HR, 1.43; 95% CI, 1.00-2.04) after adjusting for confounding factors.
Single-center and observational study.
Among PD patients at a single center in China, early anuria was relatively uncommon but associated with an increased risk of mortality and PD technique failure. Incremental PD, higher baseline urine output and serum albumin, and lower daily glucose exposure were associated with a lower risk of early anuria. Clinical trials are needed to evaluate the optimal PD techniques to preserve residual kidney function and maximaze outcomes.
无尿的发生与接受腹膜透析（PD）患者更差的临床结局相关。我们的目的是调查开始PD后第一年内无尿的发生率、危险因素及相关临床结局。
回顾性队列研究。
纳入2006年至2020年在我们中心开始持续性非卧床腹膜透析的患者，并随访至2023年1月31日。
年龄、性别、糖尿病、临时血液透析、血管紧张素转换酶抑制剂（ACEI）或血管紧张素II受体阻滞剂（ARB）、利尿剂、基线尿量、血清白蛋白、每日葡萄糖暴露量、腹膜炎及递增式PD。
主要结局为早期无尿，定义为开始PD后第一年内24小时尿量≤100 mL。次要结局包括全因死亡率、心血管疾病死亡率、技术失败及腹膜炎。
Cox比例风险模型。
共纳入2592例接受持续性非卧床腹膜透析的患者，年龄46.7±14.9岁。其中，58.9%为男性，24.0%患有糖尿病。在PD治疗的第一年内，159例（6.13%）患者出现无尿症，中位持续时间为7.53（四分位间距，3.93 - 10.0）个月。较高的基线尿量（风险比[HR]，0.93；95%置信区间[CI]，0.90 - 0.97）、较高的血清白蛋白（HR，0.92；95% CI，0.88 - 0.95）、PD前患有糖尿病（HR，0.57；95% CI，0.35 - 0.92）以及采用递增式PD（HR，0.27；95% CI，0.14 - 0.51）与早期无尿风险降低相关，而较高的每日葡萄糖暴露水平（HR，1.01；95% CI，1.00 - 1.01）被确定为早期无尿的危险因素。亚组分析显示，在糖尿病患者中使用ACEI或ARB与早期无尿风险较低相关（HR，0.25；95% CI，0.09 - 0.69）。将早期无尿作为时间依赖性协变量处理，在调整混杂因素后，早期无尿与全因死亡率（HR，1.69；95% CI，1.23 - 2.32）和技术失败（HR，1.43；95% CI，1.00 - 2.04）风险较高相关。
单中心观察性研究。
在中国一个单中心的PD患者中，早期无尿相对不常见，但与死亡率和PD技术失败风险增加相关。递增式PD、较高的基线尿量和血清白蛋白以及较低的每日葡萄糖暴露与早期无尿风险较低相关。需要进行临床试验以评估保留残余肾功能并使结局最大化的最佳PD技术。
