Peritoneal Transport Characteristics, Comorbid Diseases and Survival in CAPD Patients
Peritoneal Transport Characteristics, Comorbid Diseases and Survival in CAPD Patients
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CAPD 患者的腹膜转运特征、合并症和生存率
DOI：
10.1177/089686080002000509
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发表时间：
2000
影响因子：
2.8
通讯作者：
Hi
中科院分区：
文献类型：
--
作者：
S. Chung;Won Suk Chu;H. A. Lee;Yong Hwa Kim;In Sang Lee;B. Lindholm;Hi
目的探讨初始腹膜转运率、血清白蛋白浓度及合并症对持续不卧床腹膜透析（CAPD）患者生存率的影响。设计：前瞻性单中心研究，长期随访。本研究包括总共213名连续的CAPD患者，他们在开始CAPD后平均7天（范围3 - 30天）接受腹膜平衡试验（PET）。120例患者为男性，116例患者患有共病，平均年龄为49.5岁（范围18 - 76岁）。方法采用4.25%葡萄糖透析液进行PET检查。根据4小时留置时透析液与血浆肌酐浓度比（D4/P4 Cr，0.62 ± 0.14），将患者分为高（H）、高平均（HA）、低平均（LA）或低（L）转运蛋白。结果213例患者中，H转运体占16.9%，HA占30.5%，LA占36.6%，L转运体占16.0%。H转运蛋白组男性比例较高，合并症患者比例较高，初始血清白蛋白浓度较低，D4/D 0葡萄糖较低，引流量较低。初始D4/P4 Cr与初始血清白蛋白相关（r =-0.35，p < 0.001）。合并症患者初始血清白蛋白较低，初始D4/P4 Cr较高。在Kaplan-Meier分析中，H组的2年患者生存率显著低于其他组（57.1% vs 79.5%，p = 0.009）。在考克斯比例风险分析中，发现年龄、共病、初始血清白蛋白浓度和初始D4/P4 Cr是死亡率的独立危险因素。然而，在没有合并症的患者中，H组和其他转运组的患者生存率没有差异（p > 0.05），只有年龄是死亡率的独立危险因素。结论这些数据表明，高腹膜转运率在初始PET与高死亡率，这是部分原因是由于在H转运共病的患病率增加。这些患有共病的H转运蛋白代表了预后特别差的患者的一个子集。在无合并症的患者中，高转运状态或低血清白蛋白浓度不是死亡的独立危险因素。
Objective To evaluate the influence of initial peritoneal transport rate, serum albumin concentration, and comorbid diseases on continuous ambulatory peritoneal dialysis (CAPD) patient survival. Design A prospective single-center study with a long-term follow-up. Patients A total of 213 consecutive CAPD patients, who underwent a peritoneal equilibration test (PET) at a mean of 7 days (range 3 – 30 days) after beginning CAPD, were included in this study. One hundred twenty patients were male, 116 patients had comorbid diseases, and mean age was 49.5 years (range 18 – 76 years). Methods A modified PET was performed using 4.25% glucose dialysis solution. Based on the dialysate-to-plasma creatinine concentration ratio at 4 hours’ dwell (D4/P4 Cr, 0.62 ± 0.14), patients were divided into high (H), high-average (HA), low-average (LA), or low (L) transporters. Results Of 213 patients, 16.9% were classified as H transporters, 30.5% as HA, 36.6% as LA, and 16.0% as L transporters. The H transporter group had a higher proportion of men, higher proportion of patients with comorbid diseases, lower initial serum albumin concentration, lower D4/D0 glucose, and lower drained volume. The initial D4/P4 Cr correlated with initial serum albumin (r = –0.35, p < 0.001). The patients with comorbid diseases had lower initial serum albumin and higher initial D4/P4 Cr. On Kaplan–Meier analysis, 2-year patient survival of group H was significantly lower compared to the other groups combined (57.1% vs 79.5%, p = 0.009). On Cox proportional hazards analysis, age, comorbid diseases, initial serum albumin concentration, and initial D4/P4 Cr were found to be independent risk factors for mortality. However, in the patients without comorbid diseases, patient survival was not different between group H and the other transport groups combined (p > 0.05), and only age was found to be an independent risk factor for mortality. Conclusion These data suggest that a high peritoneal transport rate at initial PET is associated with high mortality, and that this is in part due to an increased prevalence of comorbid disease in H transporters. These H transporters with comorbid diseases represent a subset of patients with an especially poor prognosis. In patients without comorbid diseases, high transport status or low serum albumin concentration was not an independent risk factor for mortality.
DOI：
10.1016/s0272-6386(98)70174-x
发表时间：
1998-12-01
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Yeun, J Y;Kaysen, G A
通讯作者：
Kaysen, G A
DOI：
--
发表时间：
1998-12
期刊：
Journal of the American Society of Nephrology : JASN
影响因子：
--
作者：
G. Kaysen
通讯作者：
G. Kaysen