Sitter T, Krautz B, Held E, Schiffl H
Medizinische Klinik, Klinikum Innenstadt, Universität München.
Dtsch Med Wochenschr. 1997 Jan 31;122(5):109-15. doi: 10.1055/s-2008-1047583.
BACKGROUND AND OBJECTIVE OF STUDY: Continuous ambulatory peritoneal dialysis (CAPD) still plays a minor role in Germany compared with haemodialysis (HD) in the management of terminal renal failure. An investigation was undertaken to compare mortality rate, change of dialysing method as well as number and duration of hospital stays of patient undergoing CAPD or HD at a nephrological centre.
All 166 patients in terminal renal failure (except those with a malignancy) admitted between January 1987 and December 1992 were included (63 women and 103 men, aged 19-84 years). The choice between the two dialysis methods was made by the patients after detailed information had been given. Taking into account basic disease and any secondary illness as well as age and sex, survival time, any change of dialysing method and hospitalisation details were prospectively analysed for the two dialysing methods.
After 4 years there were no significant differences in mortality rate between the two methods (HD 37%, CAPD 29%). The Cox model revealed no influence of various parameters on the mortality rate of the two methods. However, cumulative patients survival was significantly decreased by arterio-sclerotic disease (P < 0.05; probability of survival after 4 years was 53% and 73%, respectively, for HD and 57% and 77% for CAPD). Similarly, age > or = 60 years at onset of dialysis significantly lowered probability of survival (after 4 years of dialysis, 53% vs 70% for HD, 45% vs 80% for CAPD: P < 0.05). But there were no significant differences between the two methods with respect to these two factors. After 4 years, "method survival" was more common with HD (94%) than CAPD (64%), P < 0.05). In particular diabetics had a significantly lower "method survival" after 4 years than non-diabetics (29% vs 74%). There was no significant difference between the two methods regarding number and duration of hospital stays.
These data show that, in a nephrological centre with long experience in both methods of dialysis, CAPD is an equal alternative to HD.
研究背景与目的：在德国，与血液透析（HD）相比，持续性非卧床腹膜透析（CAPD）在终末期肾衰竭的治疗中仍发挥着较小的作用。本研究旨在比较在一个肾脏病中心接受CAPD或HD治疗的患者的死亡率、透析方式的改变以及住院次数和住院时间。
纳入1987年1月至1992年12月期间收治的所有166例终末期肾衰竭患者（不包括患有恶性肿瘤的患者）（63例女性和103例男性，年龄19 - 84岁）。在向患者详细介绍两种透析方法后，由患者自行选择。考虑到基础疾病、任何继发性疾病以及年龄和性别，对两种透析方法的生存时间、透析方式的任何改变以及住院细节进行前瞻性分析。
4年后，两种方法的死亡率无显著差异（HD为37%，CAPD为29%）。Cox模型显示各种参数对两种方法的死亡率均无影响。然而，动脉硬化疾病显著降低了累积患者生存率（P < 0.05；4年后HD的生存率分别为53%和73%，CAPD为57%和77%）。同样，透析开始时年龄≥60岁显著降低了生存率（透析4年后，HD为53%对70%，CAPD为45%对80%：P < 0.05）。但在这两个因素方面，两种方法之间无显著差异。4年后，HD的“方法生存率”（94%）比CAPD（64%）更常见，P < 0.05。特别是糖尿病患者4年后的“方法生存率”显著低于非糖尿病患者（29%对74%）。两种方法在住院次数和住院时间方面无显著差异。
这些数据表明，在对两种透析方法都有长期经验的肾脏病中心，CAPD是HD的同等替代方法。
