Lee H B, Song K I, Kim J H, Cha M K, Park M S
Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea.
Perit Dial Int. 1996;16 Suppl 1:S269-74.
Diabetic nephropathy has emerged as a major cause of ESRD over the past decade, being the most prevalent cause of ESRD requiring dialysis in North America (United States and Canada) and the second highest in the incidence rate in Europe, Japan, Korea, Australia, and New Zealand. A greater proportion of older patients and of patients with diabetic nephropathy and other comorbid conditions has been treated with CAPD. Despite the preferential use of CAPD to treat a high-risk group of patients, the overall and/or selection-adjusted mortality was similar between HD and CAPD groups. Among diabetic patients, selection-adjusted mortality was similar between HD and CAPD or lower in CAPD than in HD, the difference being greatest among younger patients and significant through the age of 52, or higher in CAPD than in HD with higher risk of death for older diabetics (age > or = 50 years), but with similar risk among younger diabetics (age < 50 years). Technique survival was also variably reported as similar between HD and CAPD, lower, or higher with CAPD compared to HD. Diabetic CAPD patients had more hospital admissions and more days in the hospital and higher withdrawal rates from dialysis compared to diabetic HD patients. These disparate results of patient and technique survival between HD and CAPD in diabetic patients may have resulted from patient selection criteria with different comorbid conditions on entrance to dialysis, quantity of dialysis, and other unrecognized factors. Prospective randomized studies are needed to assign a cause-and-effect relationship between the choice of dialysis modality and patient and technique survival among patients with diabetes mellitus as well as with all other diagnostic categories.
在过去十年中，糖尿病肾病已成为终末期肾病（ESRD）的主要病因，是北美（美国和加拿大）需要透析的ESRD最常见病因，在欧洲、日本、韩国、澳大利亚和新西兰的发病率排名第二。接受持续性非卧床腹膜透析（CAPD）治疗的老年患者以及患有糖尿病肾病和其他合并症的患者比例更高。尽管优先使用CAPD治疗高危患者群体，但血液透析（HD）组和CAPD组的总体死亡率和/或经选择调整后的死亡率相似。在糖尿病患者中，经选择调整后的死亡率在HD组和CAPD组之间相似，或CAPD组低于HD组，这种差异在年轻患者中最大，在52岁之前都很显著；对于老年糖尿病患者（年龄≥50岁），CAPD组的死亡率高于HD组且死亡风险更高，但年轻糖尿病患者（年龄<50岁）的风险相似。技术生存率的报告也各不相同，HD组和CAPD组相似，或CAPD组低于HD组，或高于HD组。与糖尿病HD患者相比，糖尿病CAPD患者住院次数更多、住院天数更多且透析退出率更高。糖尿病患者中HD组和CAPD组在患者和技术生存率方面的这些不同结果可能是由于透析开始时合并症不同的患者选择标准、透析量以及其他未识别因素导致的。需要进行前瞻性随机研究，以确定糖尿病患者以及所有其他诊断类别的患者在透析方式选择与患者和技术生存率之间的因果关系。
