| Objective: To compare the survival prognosis of patients undergoing assisted peritoneal dialysis(a PD) and the elderly patients on the a PD with that of patients undergoing self-care peritoneal dialysis(s PD) and to investigate the risk factors affecting the survival of these patients.Materials:1. Patients undergoing peritoneal dialysis(PD) at the dialysis center of the Second Affiliated Hospital of Suzhou University from December 1, 1999 to October 30, 2013 were selected for follow-up until March 30, 2015. The included patients were divided into the a PD group and the s PD group according to whether the patient could independently complete the PD procedure. These patients who were older than 65 years were included in the elderly assisted peritoneal dialysis study. The final outcomes included the status of continued dialysis, death, and transferring to hemodialysis at the closing date of the follow-up. All patients were roughly matched for gender and age, primary kidney disease, status of diabetes mellitus, catheterization date, and laboratory indicators in any test performed during 3-6 months of regular dialysis.2. The survival rate and the technical survival rate of the patients in each group were calculated using the Kaplan-Meier method, and the hazard ratio(HR) was calculated using the multivariate Cox regression model.3. Statistical analysis was performed using SPSS for Windows, version 19.0(SPSS Inc.Chicago, IL, USA),and p<0.05 was considered statistical significance.Results:1. A total of 420 patient cases were included in this study, with 300 cases in the s PD group and 120 cases in the a PD group.(1) At the baseline, the a PD group exhibited significantly lower levels of follow-up time, parathyroid hormone(PTH),serum creatinine(Scr), plasma albumin(Alb), serum potassium(K) and serum phosphorus(P) compared to those in the s PD group(p<0.001), while the average age and incidence of diabetes of these patients were significantly higher than those of the s PD group(p<0.001).(2) The 1-year, 3-year, and 5-year survival rates of the patients in the a PD group were 81.9%, 47.4%, and 23.9%, respectively, and these rates in the s PD group were 96.6%, 84.3%, and 76.9%, respectively, p<0.001. The differences in the technical survival rates between the two groups were not statistically significant(p=0.38).(3) The multivariate analysis with the Cox risk model revealed that age(HR=1.023, p=0.009), a PD(HR=2.352, p<0.001), diabetes(HR=1.781, p=0.004), residual renal estimated glomerular filtration rate(e GFR)(HR=0.893, p=0.003), and Alb(HR=0.926, p<0.001) are the independent risk factors that affect survival rate. However, the Alb(HR=0.923, p=0.001) and age(HR=0.973, p=0.002) are the independent risk factors that affect technical survival rate.2. A total of 177 patient cases were included in the elderly assisted peritoneal dialysis study, with 88 cases in the s PD group and 89 cases in the a PD group.(1) At the baseline, the a PD group exhibited significantly lower levels of follow-up time, residual renal e GFR, PTH and Alb, compared to those in the s PD group(p<0.01), while the average age(76.51±5.93) was significantly higher than those of the s PD group(71.82±4.85)(p<0.001).(2) The 1-year, 3-year, and 5-year survival rates of the patients in the a PD group were 81.7%, 44.0%, and 18.3%, respectively, and these rates in the s PD group were 95.5%, 69.2%, and 60.9%, respectively, p<0.001. The differences in the technical survival rates between the two groups were not statistically significant(p=0.289).(3) The multivariate analysis with the Cox risk model revealed that a PD(HR=2.489, p<0.001), residual renal e GFR(HR=0.855, p=0.005), and Alb(HR=0.946,p=0.012) are the independent risk factors that affect survival rate. However, total fractional clearance of urea as a function of its distribution volume(KT/V)(HR=3.342, p=0.008) is the independent risk factor that affects technical survival rate.Conclusion:1. The survival rate of the patients undergoing a PD was lower than that of the patients undergoing s PD, with no significant difference in the technical survival rate.2. For all of the dialysis patients, age, a PD, diabetes, residual renal e GFR, and hypoalbuminemia all affected the risk of death, and a PD is an independent risk factor affecting survival rate.3. For all of the dialysis patients, age and hypoalbuminemia affected the risk of technical survival rate. KT/V is the independent risk factor that affects technical survival rate in the elderly PD patients.4. When AAPD is not available, a PD is still an alternative treatment for those ESRD patients without self-care ability. |
PDF Full Text Request