Impact of initial dialysis modality on the survival of patients with ESRD in eastern China: a propensity-matched study
Impact of initial dialysis modality on the survival of patients with ESRD in eastern China: a propensity-matched study
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初始透析方式对中国东部 ESRD 患者生存的影响：一项倾向匹配研究
DOI：
10.1186/s12882-020-01909-3
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发表时间：
2020-07
期刊：
影响因子：
2.3
通讯作者：
Chen Jianghua
中科院分区：
文献类型：
--
作者：
Yao Xi;Lei Wenhua;Shi Nan;Lin Weiqiang;Du Xiaoying;Zhang Ping;Chen Jianghua
关于血液透析（HD）和腹膜透析（PD）的生存差异，研究结果相互矛盾。本研究估计了中国东部地区HD和PD合并终末期肾病（ESRD）患者的生存和相对死亡风险。方法选取2010年1月至2014年12月在浙江省接受透析治疗的ESRD患者为研究对象，随访至2015年底。PD患者与HD患者按1:1配对，采用Kaplan-Meier分析探讨两者的生存率。应用Cox比例风险回归模型确定通过治疗方式预测生存的因素。根据性别、年龄、ESRD病因和合并症对患者进行分层，进行亚组分析。结果共纳入22,379例患者（17,029例HD患者和5350例PD患者），鉴定出5350对配对配对，中位随访时间为29个月（3 ~ 72个月）。Kaplan-Meier生存曲线显示，经性别、年龄、ESRD的主要原因和合共病调整后，HD患者的总死亡率显著高于PD患者（log-rank检验，P< 0.001）。在匹配的队列中，与PD相比，HD始终与道德风险增加相关（校正风险比（AHR）： 1.140, 95%CI: 1.023 ~ 1.271）。在亚组分析中，调整协变量后年龄小于65岁的男性、年轻患者或非糖尿病患者，与HD相比，PD患者的死亡率显著降低。在多变量Cox比例风险模型中，年龄、糖尿病肾病（DN）、其他/未知原因导致ESRD、是否有心血管疾病或癌症史对ESRD患者的生存率有统计学意义。结论：与HD患者相比，开始透析伴PD的esrd患者生存率更高。在中国，可以鼓励ESRD患者增加PD作为初始透析方式。
BackgroundThere are conflicting research results about the survival differences between hemodialysis(HD) and peritoneal dialysis (PD). The present study estimated the survival and the relative mortality hazard for incident HD and PD patients with end stage renal disease (ESRD) in eastern China.MethodsThis study examined a cohort of patients with ESRD who initiated dialysis therapy in Zhejiang province between Jan of 2010 and Dec of 2014, followed up until the end of 2015. PD patients were matched in a 1:1 fashion with HD patients, and Kaplan–Meier analysis was used to explore the survival of them. The Cox proportional hazard regression model was applied to identify the factors that predict survival by treatment modality. Subgroup analyses were conducted by stratifying patients according to gender, age, causes of ESRD and comorbidities.ResultsAmong a total of 22,379 enrolled patients (17,029 HD patients and 5350 PD patients), 5350 matched pairs were identified, and followed for a median of 29 months (3 ~ 72 months). Kaplan-Meier survival curve revealed that overall mortality rate was significantly higher in HD patients than in PD patients (log-rank test,P< 0.001), after adjusting by gender, age, primary causes of ESRD and comorbidities. HD was consistently associated with an increased risk for morality compared with PD in the matched cohort (adjusted hazard ratio (AHR): 1.140, 95%CI: 1.023 ~ 1.271). In subgroup analyses, male, younger patients, or nondiabetic patients aged less than 65 years after adjustment of covariates, initiating with PD was associated with a significantly lower mortality compared with HD. In the multivariate Cox proportional risks model, age, diabetic nephropathy (DN), other/unknown causes of ESRD, and patients with a history of cardiovascular disease or cancer showed statistical significance in explaining survival of incident ESRD patients.ConclusionsESRD patients who initiated dialysis with PD yielded superior survival rates compared to HD. Increased use of PD as initial dialysis modality in ESRD patients could be encouraged in Chinese population.
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