Nocturnal Hemodialysis Compared with Conventional Dialysis for End-Stage Renal Disease Treatment in Polycystic Kidney Disease Patients
Nocturnal Hemodialysis Compared with Conventional Dialysis for End-Stage Renal Disease Treatment in Polycystic Kidney Disease Patients
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夜间血液透析与传统透析治疗多囊肾终末期肾病的比较
DOI：
10.1159/000503679
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发表时间：
2020
影响因子：
3
通讯作者：
Yu Shengqiang
中科院分区：
文献类型：
--
作者：
Xue Cheng;Sun Bo;Ye Xiaofei;Zhou Chenchen;Yang Bo;Zhang Liming;Yu Shengqiang
背景：常染色体显性遗传性多囊肾病（ADPKD）是终末期肾病（ESRD）最常见的遗传性病因。对伴有终末期肾病的ADPKD患者进行中心夜间血液透析（NHD）治疗后的结局知之甚少。目的：本研究旨在评价中心NHD与常规血液透析（CHD）和腹膜透析（PD）治疗ADPKD的效果。方法：我们使用2000年至2016年医院数据库中ADPKD成人ESRD患者的数据。使用倾向评分匹配、竞争风险回归和考克斯回归模型进行分析。结果：共纳入170例ADPKD患者。中位随访时间为5.5年。在总体多变量校正分析中，NHD与CHD（风险比[HR] 1.33，95% CI 0.26-6.73，p = 0.31）和PD（HR 1.06，95% CI 0.14-7.71，p = 0.55）的死亡风险无显著差异。3组之间的总生存率也无显著差异（p = 0.88）。根据倾向评分，26名CHD患者和26名PD患者成功与13名NHD患者匹配。在匹配分析中，与CHD（HR 2.14，95% CI 0.33-14.00，p = 0.31）和PD（HR 0.68，95% CI 0.52-8.94，p = 0.55）相比，NHD与较低的死亡风险无关。当将肾移植作为竞争性事件处理时，结果相似。然而，与PD相比，NHD的并发症发生率较低（38.5% vs. 84.6%，p = 0.003），血清白蛋白水平较高（p < 0.001）。结论：在这项初步研究中，与传统透析方式相比，NHD可能不是ADPKD患者生存率更好的选择。NHD患者的并发症比PD少。未来的研究需要大样本量和更长的随访时间。
Background: Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary cause of end-stage renal disease (ESRD). Little is known about outcomes after in-center nocturnal hemodialysis (NHD) treatment in ADPKD patients with ESRD. Objectives: This study aimed to evaluate the effects of in-center NHD compared with conventional hemodialysis (CHD) and peritoneal dialysis (PD) in ADPKD. Methods: We used data of ADPKD adult patients with ESRD in the hospital database from 2000 to 2016. Propensity score matching, competing-risk regression, and Cox regression models were used for analysis. Results: A total of 170 ADPKD patients were included. The median follow-up time was 5.5 years. In the overall multivariate-adjusted analysis, no significant difference of mortality risk was found in NHD vs. CHD (hazard ratio [HR] 1.33, 95% CI 0.26–6.73, p = 0.31) and PD (HR 1.06, 95% CI 0.14–7.71, p = 0.55), respectively. The overall survival rate also was not significantly different among the 3 groups (p = 0.88). Based on the propensity score, 26 patients on CHD and 26 patients on PD were successfully matched to 13 NHD patients. In the matched analysis, NHD was not associated with a lower risk of mortality compared with CHD (HR 2.14, 95% CI 0.33–14.00, p = 0.31) and PD (HR 0.68, 95% CI 0.52–8.94, p = 0.55). The result was similar when treating renal transplantation as a competing event. However, NHD was associated with a lower rate of complications (38.5 vs. 84.6%, p = 0.003) and a higher level of serum albumin (p < 0.001) compared with PD. Conclusions: NHD may not be a better choice in survival compared with conventional dialysis modalities for ADPKD patients in this pilot study. Patients in NHD have fewer complications than PD. Future studies with large sample sizes and longer follow-up are required.