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目的观察成人多囊肾(PKD)终末期肾病(ESRD)患者的临床指标、透析方式和结局,评价PKD导致ESRD患者接受长期腹膜透析治疗的可行性。方法回顾性收集1993年1月至2015年12月北京协和医院确诊PKD的ESRD患者的临床资料,根据透析方式分为腹膜透析(PKD-PD)组、血液透析(PKD-HD)组,从622例腹膜透析患者中以1∶3选择年龄、性别、开始透析时间与PKD-PD组匹配的非PKD腹膜透析患者作为对照(非PKD-PD组)。以死亡为主要终点事件,利用Kaplan-Meier计算生存率,利用Cox回归模型分析影响患者生存的危险因素。结果共47例PKD患者,包括PKD-PD组33例、PKD-HD组14例,纳入非PKD-PD患者42例作为对照。PKD患者平均年龄(53±11)岁,其中女性患者18例(38.3%)。PKD-PD组与PKD-HD组患者开始透析时年龄、性别、合并症、肾脏大小、残肾功能等差异无统计学意义(P均>0.05)。PKD-PD组平均透析时间(36.2±33.1)个月,透析3个月、1年、3年、5年每周尿素清除指数、每周肌酐清除率、残肾功能年下降率与非PKD-PD组相比差异均无统计学意义(P均>0.05)。平均腹膜炎发生率为1次/84.5个月,透析1年、3年、5年生存率分别为85.7%、78.6%、78.6%,与PKD-HD组、非PKD-PD组相比差异均无统计学意义(P均>0.05)。Cox多因素回归分析显示透析方式不是影响PKD患者预后的独立危险因素。结论腹膜透析可以用于部分PKD导致ESRD患者的长期肾脏替代治疗。
Objective To observe the clinical features, dialysis modalities and outcome of patients with end-stage renal disease (ESRD) caused by adult polycystic kidney disease (PKD) and evaluate the feasibility of long-term peritoneal dialysis treatment in patients with ESRD undergoing PKD. Methods The clinical data of ESRD patients diagnosed with PKD from Peking Union Medical College Hospital from January 1993 to December 2015 were retrospectively collected and divided into PKD-PD group and PKD-HD group according to dialysis method. Patients in the peritoneal dialysis group were selected as controls (non-PKD-PD group) with non-PKD peritoneal dialysis patients whose age and sex were selected at 1: 3 and their dialysis duration was matched to PKD-PD group. With death as the primary endpoint, Kaplan-Meier was used to calculate the survival rate and the Cox regression model was used to analyze the risk factors influencing patient survival. Results A total of 47 PKD patients, including 33 cases of PKD-PD group and 14 cases of PKD-HD group, were included in the study. The average age of patients with PKD (53 ± 11) years, of which 18 cases of female patients (38.3%). There were no significant differences in age, gender, comorbidities, renal size and residual renal function between the patients with PKD-PD and those with PKD-HD (all P> 0.05). PKD-PD group, the average dialysis time (36.2 ± 33.1) months, 3 months, 1 year, 3 years, 5 years dialysis urea clearance index, weekly creatinine clearance, residual renal function decline rate and non-PKD- There was no significant difference between PD group (P> 0.05). The average incidence of peritonitis was 1 /84.5months, and the 1-year, 3-year and 5-year hemodialysis rates were 85.7%, 78.6% and 78.6% respectively. There was no difference between PKD-HD group and non-PKD-PD group Statistical significance (P> 0.05). Cox regression analysis showed that dialysis was not an independent risk factor for the prognosis of patients with PKD. Conclusion Peritoneal dialysis can be used for partial PKD in long-term renal replacement therapy in patients with ESRD.