维持性腹膜透析和血液透析治疗儿童终末期肾病的临床分析和疗效比较
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摘要
目的分析腹膜透析(peritoneal dialysis,PD)和血液透析(hemodialysis,HD)治疗儿童终末期肾病(end-stage renal disease,ESRD)临床特征和疗效比较。方法收集2011年1月～2018年6月在复旦大学附属儿科医院接受透析治疗的ESRD患儿资料,比较2组临床特征和转归。结果 231例PD和50例HD患儿纳入研究,PD组起始透析年龄小于HD组(t=-4.998,P<0.001),透析随访中血红蛋白(t=0.560,P=0.576)、血钙(t=0.000,P=1.000)、血磷(t=0.448,P=0.657)、甲状旁腺素(t=-1.828,P=0.069)、超声心动图左室重量指数(Z=-0.750,P=0.455)等均无差异。PD组待肾时间与HD组相仿(t=-0.733,P=0.467),2组患儿转归无差异(P=0.334)。结论 82%患儿以PD为首选透析模式,PD和HD在ESRD并发症、待肾时间和转归方面均相似。
Objectives To investigate the clinical characteristics and outcome of end-stage renal disease(ESRD) children treated with peritoneal dialysis(PD) and hemodialysis(HD). Methods Clinical data of ESRD children who received PD or HD in Children's Hospital of Fudan University from January 2011 to June 2018 were collected. Clinical parameters, ESRD complications, time to transplantation and outcome were compared between PD and HD groups. Results A total of 231 cases who received PD and 50 cases who received HD were enrolled in this study. The mean age was younger in PD group than in HD group(t=-4.998, P<0.001). There were no significant differences in parameters during dialysis period, including hemoglobin(t=0.560, P=0.576), serum calcium(t=0.000, P=1.000) and phosphate(t=0.448, P=0.657), PTH(t=-1.828, P=0.069) and left ventricular mass index(Z=-0.750, P=0.455). The time to transplantation(t=-0.733,P=0.467) and outcome(P=0.334) were similar between PD and HD groups. Conclusion Most cases(82%)received PD as the first dialysis modality. ESRD complications, time to transplantation and outcomes were similar for children initiated on PD or HD therapy.
Objectives To investigate the clinical characteristics and outcome of end-stage renal disease(ESRD) children treated with peritoneal dialysis(PD) and hemodialysis(HD). Methods Clinical data of ESRD children who received PD or HD in Children's Hospital of Fudan University from January 2011 to June 2018 were collected. Clinical parameters, ESRD complications, time to transplantation and outcome were compared between PD and HD groups. Results A total of 231 cases who received PD and 50 cases who received HD were enrolled in this study. The mean age was younger in PD group than in HD group(t=-4.998, P<0.001). There were no significant differences in parameters during dialysis period, including hemoglobin(t=0.560, P=0.576), serum calcium(t=0.000, P=1.000) and phosphate(t=0.448, P=0.657), PTH(t=-1.828, P=0.069) and left ventricular mass index(Z=-0.750, P=0.455). The time to transplantation(t=-0.733,P=0.467) and outcome(P=0.334) were similar between PD and HD groups. Conclusion Most cases(82%)received PD as the first dialysis modality. ESRD complications, time to transplantation and outcomes were similar for children initiated on PD or HD therapy.
引文
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[16]刘翠兰,刘华,闫志云.血液透析与腹膜透析对糖尿病肾病尿毒症高血压的临床观察[J].河北医药,2014(9):1334-1335.
[17]Wetmore JB,Peng Y,Monda KL,et al.Trends in anemia management practices in patients receiving hemodialysis and peritoneal dialysis:a retrospective cohort analysis[J].Am J Nephrol,2015,41(4-5):354-361.
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[19]Noshad H,Sadreddini S,Nezami N,et al.Comparison of outcome and quality of life:haemodialysis versus peritoneal dialysis patients[J].Singapore Med J,2009,50(2):185-192.
[20]Yang F,Khin LW,Lau T,et al.Hemodialysis versus Peritoneal Dialysis:A Comparison of Survival Outcomes in South-East Asian Patients with End-Stage Renal Disease[J].PLoS One,2015,10(10):e140195.
[21]Vidal E,Chesnaye NC,Paglialonga F,et al.A propensity-matched comparison of hard outcomes in children on chronic dialysis[J].Eur J Pediatr,2018,177(1):117-124.
[22]Vidal E,Van Stralen KJ,Chesnaye NC,et al.Infants Requiring Maintenance Dialysis:Outcomes of Hemodialysis and Peritoneal Dialysis[J].Am J Kidney Dis,2017,69(5):617-625.
[2]Niakas D,Kontodimopoulos N.Is renal transplantation the most cost-effective and preferable therapy for patients suffering from end-stage renal disease or not?[J].Health Policy,2009,89(3):329-331.
[3]Jha V.End-stage renal care in developing countries:the India experience[J].Ren Fail,2004,26(3):201-208.
[4]Schaefer F,Warady BA.Peritoneal dialysis in children with end-stage renal disease[J].Nat Rev Nephrol,2011,7(11):659-668.
[5]Litwin M,Grenda R,Prokurat S,et al.Patient survival and causes of death on hemodialysis and peritoneal dialysis--single-center study[J].Pediatr Nephrol,2001,16(12):996-1001.
[6]Majkowicz M,Afeltowicz Z,Lichodziejewska-Niemierko M,et al.Comparison of the quality of life in hemodialysed(HD)and peritoneally dialysed(CAPD)patients using the EORTC QLQ-C30 questionnaire[J].Int J Artif Organs,2000,23(7):423-428.
[7]Zhang AH,Cheng LT,Zhu N,et al.Comparison of quality of life and causes of hospitalization between hemodialysis and peritoneal dialysis patients in China[J].Health Qual Life Outcomes,2007,5(1):49-55.
[8]Feneberg R,Warady BA,Alexander SR,et al.The International Pediatric Peritoneal Registry:a global internet-based initiative in pediatric dialysis[J].Perit Dial Int,2005,25(Suppl 3):130-134.
[9]Chua AN,Warady BA.Care of the Pediatric Patient on Chronic Dialysis[J].Adv Chronic Kidney Dis,2017,24(6):388-397.
[10]Schaefer F,Borzych-Duzalka D,Azocar M,et al.Impact of global economic disparities on practices and outcomes of chronic peritoneal dialysis in children:insights from the International Pediatric Peritoneal Dialysis Network Registry[J].Perit Dial Int,2012,32(4):399-409.
[11]Warady BA,Feneberg R,Verrina E,et al.Peritonitis in children who receive long-term dialysis:a prospective evaluation of therapeutic guidelines[J].J Am Soc Nephrol,2007,18(7):2172-2179.
[12]林明增,陈霄峰,范佳妮,等.腹膜透析和血液透析对尿毒症患者钙磷代谢影响的临床研究[J].中国血液净化,2013,12(9):487-490.
[13]杨芳,蒋小英.腹膜透析与血液透析对心脏瓣膜钙化的影响[J].浙江临床医学,2015,17(9):1556-1557.
[14]Chen YC,Lin CJ,Wu CJ,et al.Comparison of extracellular volume and blood pressure in hemodialysis and peritoneal dialysis patients[J].Nephron Clin Pract,2009,113(2):112-116.
[15]林静,丁小强,吉俊,等.慢性肾脏病患者高血压现状的横断面调查[J].中华肾脏病,2009,25(11):827-831.
[16]刘翠兰,刘华,闫志云.血液透析与腹膜透析对糖尿病肾病尿毒症高血压的临床观察[J].河北医药,2014(9):1334-1335.
[17]Wetmore JB,Peng Y,Monda KL,et al.Trends in anemia management practices in patients receiving hemodialysis and peritoneal dialysis:a retrospective cohort analysis[J].Am J Nephrol,2015,41(4-5):354-361.
[18]袁红波,楼季庄.血液透析与腹膜透析改善肾性贫血的临床观察[J].疑难病,2011,10(3):183-185.
[19]Noshad H,Sadreddini S,Nezami N,et al.Comparison of outcome and quality of life:haemodialysis versus peritoneal dialysis patients[J].Singapore Med J,2009,50(2):185-192.
[20]Yang F,Khin LW,Lau T,et al.Hemodialysis versus Peritoneal Dialysis:A Comparison of Survival Outcomes in South-East Asian Patients with End-Stage Renal Disease[J].PLoS One,2015,10(10):e140195.
[21]Vidal E,Chesnaye NC,Paglialonga F,et al.A propensity-matched comparison of hard outcomes in children on chronic dialysis[J].Eur J Pediatr,2018,177(1):117-124.
[22]Vidal E,Van Stralen KJ,Chesnaye NC,et al.Infants Requiring Maintenance Dialysis:Outcomes of Hemodialysis and Peritoneal Dialysis[J].Am J Kidney Dis,2017,69(5):617-625.