Impact of dialysis modality on survival of new ESRD patients with congestive heart failure in the United States
Impact of dialysis modality on survival of new ESRD patients with congestive heart failure in the United States
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DOI：
10.1046/j.1523-1755.2003.00165.x
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发表时间：
2003-09-01
影响因子：
19.6
通讯作者：
Murthy, B
中科院分区：
文献类型：
--
作者：
Stack, AG;Molony, DA;Murthy, B
背景腹膜透析可能是终末期肾病（ESRD）合并充血性心力衰竭（CHF）患者的最佳治疗方法，其容量调节效果优于血液透析，这是一种假设，但尚未得到证实。使用来自医疗保险和医疗补助服务中心（CMS）医学证据表的107，922例新发ESRD患者的全国发病率数据来检验腹膜透析在延长CHF患者生存期方面上级血液透析的假设。非比例考克斯回归模型主要使用意向治疗方法，也使用实际治疗方法，通过透析方式评价了CHF患者和非CHF患者的相对死亡风险。糖尿病患者和非糖尿病患者分别进行分析。在ESRD开始时，CHF的总体患病率为33%。有27，149例死亡（25.2%），5423例移植（5%），3753例（3.5%）患者失访超过2年。腹膜透析治疗CHF患者的校正死亡风险显著高于血液透析[糖尿病患者，相对风险（RR）= 1.30，95%置信区间（CI）1.20 - 1.41;非糖尿病患者，RR = 1.24，95% CI 1.14 - 1.35]。在非CHF患者中，仅糖尿病患者腹膜透析的校正死亡风险高于血液透析（RR = 1.11，95%CI 1.02 ~ 1.21），而非糖尿病患者腹膜透析和血液透析的生存率相似（RR = 0.97，95%CI 0.91 ~ 1.04）。有CHF临床病史的新发ESRD患者接受腹膜透析治疗时的生存率低于血液透析。这些数据表明，腹膜透析可能不是新发CHF ESRD患者的最佳选择，可能是因为容量调节受损和心肌病恶化。
Background. It is hypothesized, but not proven, that peritoneal dialysis might be the optimal treatment for end-stage renal disease (ESRD) patients with established congestive heart failure (CHF) through better volume regulation compared with hemodialysis.Methods. National incidence data on 107,922 new ESRD patients from the Center for Medicare and Medicaid Services (CMS) Medical Evidence Form were used to test the hypothesis that peritoneal dialysis was superior to hemodialysis in prolonging survival of patients with CHF. Nonproportional Cox regression models evaluated the relative hazard of death for patients with and without CHF by dialysis modality using primarily the intent-to-treat but also the as-treated approach. Diabetics and nondiabetics were analyzed separately.Results. The overall prevalence of CHF was 33% at ESRD initiation. There were 27,149 deaths (25.2%), 5423 transplants (5%), and 3753 (3.5%) patients lost to follow-up over 2 years. Adjusted mortality risks were significantly higher for patients with CHF treated with peritoneal dialysis than hemodialysis [diabetics, relative risk (RR) = 1.30, 95% confidence interval (CI) 1.20 to 1.41; nondiabetics, RR = 1.24, 95% CI 1.14 to 1.35]. Among patients without CHF, adjusted mortality risk were higher only for diabetic patients treated with peritoneal dialysis compared with hemodialysis (RR = 1.11, 95% CI 1.02 to 1.21) while nondiabetics had similar survival on peritoneal dialysis or hemodialysis (RR = 0.97, 95% CI 0.91 to 1.04).Conclusion. New ESRD patients with a clinical history of CHF experienced poorer survival when treated with peritoneal dialysis compared with hemodialysis. These data suggest that peritoneal dialysis may not be the optimal choice for new ESRD patients with CHF perhaps through impaired volume regulation and worsening cardiomyopathy.