Epidemiology And Prognosis Analysis Of Maintenance Peritoneal Dialysis Patients

Background and Objectives:To analysis epidemiology and trend of peritoneal dialysis during 2011 to 2014 in China. To Analysis baseline data of maintenance peritoneal dialysis patients in CNRDS registration system. To explore clinical features and prognostic factors in peritoneal dialysis patients. To establish a prognostic model for predicting their first-year mortality.Methods:(1) Collected the data from the peritoneal dialysis centers, and reported and collected on line.(2) Screening the cases for aged≥18 years, CAPD≥3 months, peritoneal dialysis catheter implantation time and outcome was clear, baseline clinical indicators was complete.The study was included the continuous ambulatory peritoneal dialysis patients 25,899 cases in the registration system. Using the Kaplan-Meier curves and Log-Rank test for univariate survival analysis, screened statistically significant factors reintroduction Cox multivariate survival analysis. Found an independent risk factor for survival in patients and related technical viability. (3) A national multi-center cohort study was performed. A total of 5,405 new PD cases from China Peritoneal Dialysis Registry in 2012 were enrolled in model group. All these patients had complete baseline data and were followed for one year. Demographic and clinical features of these patients were collected. Cox proportional hazards regression model was used to analyze prognostic risk factors and establish prognostic model. A validation group was established using 1,764 new PD cases between January 1,2013 and July 1,2013, and to verify accuracy of prognostic model.Results:(1) By the end of 2014,55373 cases of maintenance peritoneal dialysis patients was in CNRDS,7891 cases (20.8%) increased per year. The annual incidence rate was 6.42/100 million people in 2014. The prevalence was 40.5/100 million people. The average age was 53.4±15.0 years. Male to female ratio was 1.19:1. The initiation of dialysis age was about 50 years old. The average residual renal function was 3.01 ml/min. The average dialysis time was 2.33 years. The primary causes were primary glomerular disease, diabetic nephropathy, hypertensive renal damage. Peritoneal dialysis access was the two cuffs, no gooseneck, straight.77.0% patients were the continuous ambulatory peritoneal dialysis patients. The therapeutic dose was 6L to 8L. High peritoneal transport type was the largest. DOR was 10.1%. TOT was 20.8 months. The average death age of the death patients was more than 63.7 years.The average therapy time was more than 26.2 months. The cause of death was the cardiovascular and cerebrovascular events. PD patients with hemoglobin≥100g/L ratio was raising year by year. The albumin≥35g/L with more than 52.5% patients. Serum calcium level was improved year by year. The Kt/V was maintained at 1.79/weeks. Ccr could reach 55.7 L/1.73 m2/ weeks. (2) Multivariate analysis showed that diabetes,24h urine≥ 400ml/d, serum albumin≥35g/L was an independent risk factor for survival in patients. Diabetes, serum albumin≥35g/L also peritoneal dialysis patients independent risk factor for techniques viability. (3) Results indicated that model group included 4,453 live PD cases and 371 dead cases. Multivariate survival analysis showed that diabetes mellitus (DM), residual glomerular filtration rate (rGFR), DBP, Kt/V, high PET type and Alb were independently associated with first-year mortality. Model was statistically significant in both within-group verification and outside-group verification.Conclusion:The annual increase of about 20.8% in peritoneal dialysis patients. The annual incidence rate was 6.42/100 million people in 2014. The prevalence was 40.5/100 million people. Different from Europe, North America and other developed countries, the time of peritoneal dialysis in China was late. The primary cause of the disease was primary glomerular disease. APD patients accounted for only 1.4%. Anemia, hypoproteinemia, calcium and phosphorus metabolism and dialysis adequacy control was better than before. Diabetes was still high risk factor in peritoneal dialysis patients. Prognosis is closely related to serum albumin levels. DM, rGFR, DBP, Kt/V, high PET type and Alb were independent risk factors for first-year mortality in PD patients. Prognostic model established in this study accurately predicted risk of short-term death in PD patients.