目的:探讨多囊肾致终末期肾病患者行腹膜透析治疗的预后情况。创新点:分析国内最大一组单中心样本关于多囊肾患者行腹膜透析治疗的预后研究,进一步证实多囊肾并非腹膜透析的禁忌症。方法:回顾性分析2007年7月1日至2014年7月31日于我院置管并开始维持性腹膜透析的30例多囊肾致终末期肾病患者,选择30例年龄及性别与多囊肾组匹配的非多囊肾患者作为对照组。记录患者一般资料、透析初始资料、并发症、生存时间、退出透析或死亡等治疗结局。采用Kaplan-Meier法和log-rank检验进行生存分析。结论:多囊肾组3年病人生存率和技术生存率分别为90.6%和89.2%,对照组为86.3%和74.3%,差异无统计学意义(图1和2)。两组患者的腹膜炎发生率分别为0.19次/病人年和0.21次/病人年(表3)。两组患者腹透液渗漏、疝气、心脑血管事件发生率之间的差异均无统计学意义(表4)。综上所述,通过合理的病人筛选和评估,多囊肾不是腹膜透析的禁忌症。
To describe the long-term clinical outcomes of patients with autosomal dominant polycystic kidney disease (ADPKD) who are on peritoneal dialysis (PD) therapy. We performed a retrospective matched-cohort analysis com- paring the clinical outcomes of 30 ADPKD patients with those of 30 non-diabetic patients who had bilateral small kidneys between July 1 2007 and July 31 2014. The patient groups were matched by age, gender, and time of PD initiation. There were no significant differences in the demographic or biochemical parameters, comorbid conditions, residual glomerular filtration rate, or Charison comorbidity score at the beginning of PD. The median renal volume was 1315 ml for the ADPKD group and 213 ml for the control group. Patients with ADPKD had similar 3-year patient survival (90.6% versus 86.3%, ,~=-0.807) and technique survival (89.2% versus 74.3%, P=0.506) compared with non-ADPKD patients. Also, there was no significant difference in the peritonitis-free survival between the ADPKD and control groups (P=0.22), and rates of peritonitis were similar (0.19 versus 0.21 episodes per patient-year, P=-0.26). No differences were observed in the incidence of PD-related complications, such as hernia and dialysate leak. ADPKD is not a con- traindication for PD, and a subgroup of ADPKD patients with relatively small kidney volume can be treated using PD.