腹膜透析患者早期残肾功能快速下降的影响因素及对生存的影响分析

发布时间：2018-01-07 02:12

  本文关键词：腹膜透析患者早期残肾功能快速下降的影响因素及对生存的影响分析　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 残肾功能 死亡率 腹膜透析

【摘要】：目的:保护残肾功能对透析病人具有非常重要的意义。既往文献中腹膜透析患者残肾功能的影响因素存在很大的争议,本研究结合腹透患者随访情况探寻早期残肾功能快速下降的影响因素及对患者生存的影响。方法:本研究为单中心回顾性研究,纳入了 2005年1月1日到2015年6月30日在浙江大学医学院附属第一医院肾脏病中心行腹膜透析的911名尿毒症患者。腹膜透析患者残肾功能的下降速率用线性回归方程的斜率表示。分析腹膜透析患者透析开始1年内残肾功能下降速率的影响因素以及与患者全因死亡的关系。结果:研究对象的平均年龄为49.4±13.9岁,55.5%的患者为男性,残肾功能下降的中位速度为 0.308(0.190-0.475)mL/month/1.73 m2。79 名患者(8.7%)在随访期间死亡。多因素线性回归分析显示了男性,非糖尿病,高水平的透前残肾功能,低尿酸,低血清白蛋白,高钙和高甲状旁腺素是腹膜透析患者透析开始1年内残肾功能下降的独立危险因素。多因素Cox比例风险回归模型显示与残肾功能下降速度慢的患者相比,残肾功能下降快的患者全因死亡率更高(Model 4;HR,2.97,95%CI,1.53 to 5.77,P = 0.001)。将残肾功能的下降速度作为一个连续变量时,1年内残肾功能每下降1 mL/month/1.73 m2与患者全因死亡的风险比为6.19(95%CI,2.97 to 12.9,P0.001)。但残肾功能的下降与患者心血管死亡无明显相关性(Model 4;HR,3.33,95%CI,0.84 to 13.1,P = 0.086)。结论:早期残肾功能的快速下降是腹膜透析患者全因死亡的独立危险因素。
[Abstract]:Objective: to protect the residual renal function has very important significance in dialysis patients. Controversial factors in peritoneal dialysis patients with residual renal function in the previous literature, this study combined with peritoneal dialysis patients were factors influencing residual renal function in the early rapid decline and affected the survival of patients. Methods: the research is to study a review of single center, in January 1, 2005 to June 30, 2015 in 911 uremic patients of Zhejiang University Medical College First Affiliated Hospital for peritoneal dialysis. The slope of residual renal function in peritoneal dialysis patients with the decreasing rate of the linear regression equation. Analysis of peritoneal dialysis patients start dialysis residual renal function within 1 years of decline rate and influence factors patients with all-cause mortality. Results: the average age of the study participants was 49.4 + 13.9 years, 55.5% of the patients were male, residual renal function decline The median rate of 0.308 (0.190-0.475) mL/month/1.73 m2.79 (8.7%) patients died during the follow-up period. The multivariate linear regression analysis showed that male, non diabetes, high level through the residual renal function, low uric acid, low serum albumin, high calcium and high PTH is dialysis in patients with peritoneal dialysis start the independent risk factors of residual renal function decline in 1 years. The multivariate Cox proportional hazard regression model showed that compared with the loss of residual renal function in patients with slow speed, residual renal function decreased quickly with all-cause mortality higher (Model 4; HR, 2.97,95%CI 1.53, to 5.77, P = 0.001). The residual renal function the rate of decline as a continuous variable, the residual renal function within 1 years of each 1 mL/month/1.73 reduction with M2 risk of all-cause mortality ratio was 6.19 (95%CI 2.97, to 12.9, P0.001). But the decline of residual renal function in patients with cardiovascular death has no obvious correlation (Model 4 HR, 3.33,95%CI, 0.84 to 13.1, P = 0.086). Conclusion: the rapid decline in the function of the early remnant kidney is an independent risk factor for all causes of death in peritoneal dialysis patients.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5
，

本文编号：1390529