Superior survival of high transporters treated with automated versus continuous ambulatory peritoneal dialysis
Superior survival of high transporters treated with automated versus continuous ambulatory peritoneal dialysis
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DOI：
10.1093/ndt/gfp780
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发表时间：
2010-06-01
影响因子：
6.1
通讯作者：
Badve, Sunil V.
中科院分区：
文献类型：
--
作者：
Johnson, David W.;Hawley, Carmel M.;Badve, Sunil V.
背景。国际腹膜透析协会 (ISPD) 广泛推荐自动腹膜透析 (APD) 用于高转运蛋白的管理，尽管迄今为止还没有足够的研究比较 APD 和连续不卧床腹膜透析 (CAPD) 在这一高危人群中的结果。方法。对1999年4月1日至2004年3月31日期间在澳大利亚或新西兰开始PD且基线腹膜平衡测试证实存在高腹膜转运状态的所有患者，通过意向治疗（第90天的PD模式）和“治疗时”时变Cox比例风险模型分析，检查APD与CAPD对患者和技术生存率的相对影响。结果。在研究期间，4128 名患者开始进行 PD。其中，628 名患者在第 90 天时为 PD 的高转运蛋白（486 名患者接受 CAPD，142 名患者接受 APD）。与接受 CAPD 治疗的高转运蛋白相比，接受 APD 治疗的高转运蛋白更有可能是年轻的白种人，并且患糖尿病的可能性较小。在多变量意向治疗分析中，APD 治疗与较高的生存率相关[调整后的风险比 (HR) 0.56，95% 置信区间 (CI) 0.35-0.87] 和可比较的死亡删失技术生存率（HR 0.88，95% CI 0.64-1.21）。补充治疗分析（HR 0.72，95% CI 0.54-0.96）、匹配病例对照分析（HR 0.60，95% CI 0.36 0.96）以及完全用 APD 治疗的高转运蛋白与完全用 CAPD 治疗的亚组分析（HR 0.29，95% CI 0.14-0.60）。对于任何其他转运组，APD 和 CAPD 之间的患者生存率或死亡审查技术生存率没有统计学上的显着差异，但低转运者除外，与 CAPD 相比，低转运者在 APD 上的死亡率更高（HR 2.19，95% CI 1.02-4.70）。结论。与 CAPD 相比，APD 治疗在高转运蛋白中具有显着的生存优势。然而，APD 治疗与低转运蛋白患者的生存率较低有关。
Background. Automated peritoneal dialysis (APD) is widely recommended for the management of high transporters by the International Society of Peritoneal Dialysis (ISPD), although there have been no adequate studies to date comparing the outcomes of APD and continuous ambulatory peritoneal dialysis (CAPD) in this high risk group.Methods. The relative impact of APD versus CAPD on patient and technique survival rates was examined by both intention-to-treat (PD modality at Day 90) and 'as-treated' time-varying Cox proportional hazards model analyses in all patients who started PD in Australia or New Zealand between 1 April 1999 and 31 March 2004 and who had baseline peritoneal equilibration tests confirming the presence of high peritoneal transport status.Results. During the study period, 4128 patients commenced PD. Of these, 628 patients were high transporters on PD at Day 90 (486 on CAPD and 142 on APD). Compared to high transporters treated with CAPD, APD-treated high transporters were more likely to be younger and Caucasian, and less likely to be diabetic. On multivariate intention-to-treat analysis, APD treatment was associated with superior survival [adjusted hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.35-0.87] and comparable death-censored technique survival (HR 0.88, 95% CI 0.64-1.21). Superior survival of high transporters treated with APD versus CAPD was also confirmed in supplemental as-treated analysis (HR 0.72, 95% CI 0.54-0.96), matched case-control analysis (HR 0.60, 95% CI 0.36 0.96) and subgroup analysis of high transporters treated entirely with APD versus those treated entirely with CAPD (HR 0.29, 95% CI 0.14-0.60). There were no statistically significant differences in patient survival or death-censored technique survival between APD and CAPD for any other transport group, except for low transporters, who experienced a higher mortality rate on APD compared with CAPD (HR 2.19, 95% CI 1.02-4.70).Conclusions. APD treatment is associated with a significant survival advantage in high transporters compared with CAPD. However, APD treatment is associated with inferior survival in low transporters.