DiabetesRes Clin Pract：持续不卧床腹透有效可靠

　　中山大学第一附属医院肾内科余学清教授等公布的一项为期5 年的临床队列研究表明， 在我国接受持续性不卧床腹膜透析（CAPD）的患者中，糖尿病并不显著影响生存率。对于接受CAPD 的糖尿病患者，启动CAPD 时高龄、合并心血管疾病、血糖水平较高、贫血和低白蛋白血症均是影响生存率的因素。（DiabetesRes Clin Pract. 2013 年4 月22 日在线版）

　　该纵向队列研究入选809例接受CAPD 的肾病患者，其中189 例（23.4%）合并糖尿病。研究者报告，糖尿病患者和非糖尿病患者的死亡审查技术（Death-censored technique）生存率无显著差异（P=0.271）。然而， 糖尿病患者1、2、3、5 年生存率依次为90%、72%、63% 和36%，非糖尿病组则依次为95%、92%、87% 和73%（P=0.000）。在启动CAPD 时，合并心血管疾病（HR=2.130，P=0.010）、高龄（HR=1.042，P=0.014）、糖化血红蛋白水平较高（HR=1.309，P=0.019）、低白蛋白血症（HR=0.924，P=0.004） 和血红蛋白水平降低（HR=0.978，P=0.003）均是糖尿病患者死亡的独立预测因素。

　　研究者观点

　　有关糖尿病腹透患者的生存率，美国USRDS 研究中患者1、3、5 年生存率依次为87.4%、54.9% 和34.8%；韩国男、女性患者3 年生存率分别为70% 和46%；我国台湾地区5 年生存率仅为26%；加拿大患者1、3、5 年生存率为91%、66% 和47%。我国患者1、3、5 年生存率依次为90%、63% 和36%，说明在基于血糖的腹透技术治疗下，我国糖尿病患者的生存率优于上述国家或地区。因此，对我国合并糖尿病的终末期肾病患者来说，CAPD 是长期肾脏替代治疗的可靠治疗模式。

与腹透相关的拓展阅读：

• 使用氨基糖苷类治疗腹透相关性腹膜炎不会影响残余肾功能 更多信息请点击：有关腹透更多资讯

Clinical outcome and risk factors for mortality in Chinese patients with diabetes on peritoneal dialysis: A 5-year clinical cohort study.
AIMS
We evaluated clinical outcome and risk factors affecting survival in patients with diabetes on continuous ambulatory peritoneal dialysis (CAPD) in Southern China.
METHODS
This longitudinal cohort study enrolled all incident patients who used CAPD as their first renal replacement therapy modality in our center from January 2006 to December 2009 and who were followed until December 2011. Clinical outcomes were compared and risk factors for mortality in patients with diabetes were analyzed.
RESULTS
Of 809 incident CAPD patients, 189 (23.4%) had diabetes. Death-censored technique survival showed no significant difference between patients with and without diabetes (p=0.271). The 1-, 2-, 3- and 5-year patient survival rates were 90%, 72%, 63% and 36% in patients with diabetes and 95%, 92%, 87% and 73% in patients without diabetes, respectively (p=0.000). Presence of cardiovascular disease (CVD) [hazard ratio (HR) 2.130, 95% confidence interval (CI) 1.199-3.786, p=0.010], advanced age (HR 1.042, 95% CI 1.008-1.078, p=0.014), higher glycated hemoglobin (HR 1.309, 95% CI 1.045-1.640, p=0.019), lower hemoglobin (HR 0.978, 95% CI 0.964-0.992, p=0.003) and lower serum albumin (HR 0.924, 95% CI 0.876-0.976, p=0.004) at the initiation of CAPD were independent risk factors of mortality in CAPD patients with diabetes.
CONCLUSIONS
Technique survival in CAPD patients with diabetes was similar to those without diabetes. Although patients with diabetes had higher risk of mortality, the patient survival in our study seems to be improved compared with most other reports. Older age, presence of CVD, hyperglycemia, anemia and hypoalbuminemia at the commencement of CAPD affected survival in patients with diabetes.