摘要
目的比较分析不合并糖尿病的终末期肾脏病患者血液透析(hemodialysis,HD)和腹膜透析(peritoneal dialysis,PD)的生存预后及其影响因素。方法回顾性分析2013年1月1日至2019年2月1日在郑州大学第一附属医院以动静脉内瘘(arteriovenous fistula,AVF)或动静脉移植(arteriovenous graft,AVG)起始行HD(hemodialysis-arteriovenous fistula/arteriovenous graft,HD-AVF/AVG)或PD且维持透析≥3个月的非糖尿病终末期肾脏病患者的临床资料,随访截至2019年5月1日。根据患者起始的透析方式,将患者分为HD组和PD组。应用Kaplan-Meier法、Log-rank检验和Cox比例风险回归模型分析患者的生存率及预后影响因素,应用逆概率处理加权法(inverse probability of treatment weighting,IPTW)消除组内混杂因素的影响。结果共纳入患者371例,其中HD组113例(30.5%),PD组258例(69.5%)。两组患者基线资料比较中,年龄、体重指数、合并脑血管疾病、Charlson合并症指数(Charlson comorbidity index,CCI)、血钾、血浆白蛋白、血红蛋白的标准均数差(standard mean difference,SMD)值均大于0.1,逆概率处理加权后SMD值下降,绝大部分小于0.1,说明加权后组间均衡性良好。加权前Kaplan-Meier生存曲线分析显示,两组患者全因死亡的累积生存率之间差异无统计学意义(Log-rankχ2=0.094,P=0.759)。利用IPTW消除组内混杂因素的影响后,Kaplan-Meier生存曲线分析显示,两组患者全因死亡的累积生存率之间差异仍无统计学意义(Log-rankχ2=2.090,P=0.150)。单因素Cox回归分析显示,以全因死亡为结局,透析方式(PD/HD,HR=1.171,95%CI 0.426~3.223,P=0.760)对不合并糖尿病的终末期肾脏病患者的生存率无显著影响。多因素Cox回归分析显示透析方式(PD/HD,HR=1.460,95%CI 0.515~4.144,P=0.477)对不合并糖尿病的终末期肾脏病患者的生存率仍无显著影响,高血浆白蛋白(HR=0.893,95%CI 0.813~0.981,P=0.019)是不合并糖尿病终末期肾脏病患者生存的独立保护因素。逆概率处理加权后,多因素Cox回归分析结果显示,透析方式(PD/HD,HR=1.842,95%CI 0.514~6.604,P=0.348)对不合并糖尿病的终末期肾脏病患者的生存率无显著影响。结论不合并糖尿病的终末期肾脏病患者HD和PD的累积生存率之间差异无统计学意义。
Objective To compare the prognosis of hemodialysis(HD)and peritoneal dialysis(PD)in end-stage renal disease(ESRD)patients without diabetes mellitus and identify related influencing factors.Methods Patients who started hemodialysis with an arteriovenous graft or fistula or PD in the First Affiliated Hospital of Zhengzhou University from January 1,2013 to February 1,2019 were included.They were followed up until May 1,2019.The patients were divided into HD group and PD group according to the initial dialysis modality.Kaplan-Meier method was used to obtain survival curves,the Cox regression model was used to evaluate influence factors for survival rates,and the inverse probability of treatment weighting(IPTW)was used to eliminate influence of the confounders in the groups.Results There were 371 patients with maintenance dialysis enrolled in this study,including 113 cases(30.5%)in HD group and 258 cases(69.5%)in PD group.At baseline,the scores of standard mean difference(SMD)in age,body mass index(BMI),combined with cerebrovascular disease,Charlson comorbidity index(CCI),blood potassium,plasma albumin and hemoglobin between the two groups were greater than 0.1.The score of SMD decreased after IPTW,and the most data were less than 0.1,which meant that the balance had been reached between the two groups.The Kaplan-Meier survival curve showed that the cumulative survival rates had no significant difference for all-cause death before using IPTW between the two groups(Log-rankχ2=0.094,P=0.759).After adjusting for confounders with IPTW,the Kaplan-Meier survival curve showed that the cumulative survival rates still had no significant difference for all-cause death between the two groups(Log-rankχ2=2.090,P=0.150).Univariate Cox regression analysis showed that there was no significant difference between HD and PD on survival rates in ESRD patients without diabetes mellitus for all-cause death(PD/HD,HR=1.171,95%CI 0.426-3.223,P=0.760).Multivariate Cox regression analysis showed that there was no significant difference between HD and PD on survival rates in ESRD patients without diabetes mellitus(PD/HD,HR=1.460,95%CI 0.515-4.144,P=0.477),and high plasma albumin(HR=0.893,95%CI 0.813-0.981,P=0.019)was an independent protective factor for survival in ESRD patients without diabetes mellitus.There was still no significant difference between HD and PD on survival rates in ESRD patients without diabetes mellitus after using IPTW(PD/HD,HR=1.842,95%CI 0.514-6.604,P=0.348).Conclusion The difference of cumulative survival rates between HD and PD is not significant in ESRD patients without diabetes mellitus.
作者
赵二丽
尚进
马爽
张丽洁
刘栋
董奕君
肖静
赵占正
Zhao Erli;Shang Jin;Ma Shuang;Zhang Lijie;Liu Dong;Dong Yijun;Xiao Jing;Zhao Zhanzheng(Department of Nephrology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2020年第6期429-434,共6页
Chinese Journal of Nephrology
基金
国家自然科学基金青年基金(81400763)。
关键词
肾透析
腹膜透析
预后
Renal dialysis
Peritoneal dialysis
Prognosis
