CHANGES IN OUTCOMES OVER TIME AMONG INCIDENT PERITONEAL DIALYSIS PATIENTS IN SOUTHERN CHINA
CHANGES IN OUTCOMES OVER TIME AMONG INCIDENT PERITONEAL DIALYSIS PATIENTS IN SOUTHERN CHINA
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中国南方地区腹膜透析患者的结局随时间的变化
DOI：
10.3747/pdi.2018.00256
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发表时间：
2019-07-01
影响因子：
2.8
通讯作者：
Yang, Xiao
中科院分区：
文献类型：
--
作者：
Peng, Yuan;Ye, Hongjian;Yang, Xiao
背景：本研究旨在调查中国南方地区2006 - 2010年和2011 - 2015年间开始腹膜透析（PD）的患者结局的变化。方法：在这项单中心队列研究中，纳入了2006年1月1日至2015年12月31日的PD患者。收集的数据包括基线人口统计学、临床、生化特征和结果。分别于2006 - 2010年和2011 - 2015年随访至2011年12月31日和2016年12月31日。比较两个事件队列的腹膜炎发生率、患者生存率和技术生存率。结果：共纳入2021例PD患者，平均年龄为47.2±15.2岁，女性占40.6%。与2006 - 2010年队列（n = 1,073）相比，2011 - 2015年（n = 948）期间开始PD的患者更年轻（46.2 +/- 14.8岁vs 48.1 +/- 15.5岁，p= 0.006），基线估计肾小球滤过率（eGFR）相似（5.81 +/- 2.41 vs 5.81 +/- 2.89 mL/min/1.73 m(2), p= 0.109），糖尿病百分比相似（24.9% vs 25.7%, p= 0.682）。2011- 2015年队列的总腹膜炎发生率低于2006 - 2010年队列（每年0.158例vs 0.161例，p = 0.001）。在1、3和5年结束时，2006 - 2010和2011 - 2015队列的患者生存率分别为94%、82%、64%和97%、87%、74% （p < 0.001）。多变量调整后，2011 - 2015年开始PD的患者与全因死亡风险较低相关（风险比[HR] 0.77, 95%可信区间[CI] 0.60 - 0.98）。在性别和年龄分层模型中，2011 - 2015年男性患者的全因死亡风险显著低于2006 - 2010年（HR 0.58, 95% CI 0.41 - 0.83），年龄< 65岁的患者心血管（CV）死亡风险显著低于2006 - 2010年（HR 0.63, 95% CI 0.40 - 0.99）。死亡审查技术生存率在两个队列之间无显著差异（p= 0.234）。结论：腹膜炎发生率和患者生存率持续提高。2011年至2015年间开始PD治疗的患者预后较好。
Background: The present study was to investigate the changes in outcomes of incident patients who started peritoneal dialysis (PD) between 2006 - 2010 and 2011 - 2015 in Southern China.Methods: In this single-center cohort study, incident PD patients from January 1, 2006, to December 31, 2015, were enrolled. Collected data included baseline demographic, clinical, biochemical characteristics, and outcomes. Patients who initiated PD during 2006 - 2010 and 2011 - 2015 were followed up until December 31, 2011, and December 31, 2016, respectively. Peritonitis rate, patient survival, and technique survival were compared between the 2 incident cohorts.Results: A total of 2,021 incident PD patients were enrolled, with a mean age of 47.2 +/- 15.2 years, 40.6% female. Compared with the 2006 - 2010 cohort (n = 1,073), patients initiating PD during 2011 - 2015 (n = 948) were younger (46.2 +/- 14.8 vs 48.1 +/- 15.5 years, p = 0.006), had similar baseline estimate glomerular filtration rate (eGFR) (5.81 +/- 2.41 vs 5.81 +/- 2.89 mL/min/1.73 m(2) , p= 0.109) and comparable percentage of diabetes mellitus (24.9% vs 25.7%, p = 0.682). The overall peritonitis rate in the 2011- 2015 cohort was lower than in the 2006 - 2010 cohort (0.158 vs 0.161 episodes per year, p = 0.001). At the end of 1, 3, and 5 years, the 2006 - 2010 and 2011 - 2015 cohorts had patient survival rates of 94%, 82%, 64%, and 97%, 87%, 74%, respectively (p < 0.001). After multivariable adjustment, patients starting PD in 2011 - 2015 were associated with lower risk of all-cause mortality (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.60 - 0.98). In gender and age-stratified models, male patients had a significantly lower risk of all-cause mortality (HR 0.58, 95% CI 0.41 - 0.83), and patients with age < 65 years showed a significantly lower risk of cardiovascular (CV) mortality (HR 0.63, 95% CI 0.40 - 0.99) in 2011 - 2015 compared with 2006 - 2010. The death-censored technique survival rates were not significantly different between the 2 cohorts (p= 0.234).Conclusion: Peritonitis rates and patient survival on PD continue to improve. Patients initiating PD between 2011 and 2015 were associated with better outcomes.