| Objective:Yunnan is located in the plateau,economic,cultural,medical and health levels are relatively backward,most of the patients at the time of treatment are in critical condition and urgently need Urgent-start dialysis.This study collected clinical data of patients with Urgent-start peritoneal dialysis,analyzed the survival rate,technical survival rate,and outcomes of patients,and explored the factors that affected the survival and prognosis of patients with Urgent-start peritoneal dialysis.Methods:This study was enrolled in.110 patients with end-stage renal disease diagnosed at the Dep artment of Nephrology,the Second Affiliated Hospital of Kunming Medical University from January 1,2013 to December 31,2014 and undergoing Urgent-start peritoneal dialysis for the first time in this hospital.In adult patients,all PD patients were followed up to peritoneal dialysis,withdrawal hemodialysis,transfer to other medical centers,kidney transplantation,death,loss of follow-up,or follow-up observation for 3 years until the study termination date(December 31,2017)patient' s medical records and follow-up data were collected,including the initial dialysis Charlson comorbidity index,gender,age,primary disease,blood pressure,height,weight,BMI,the time to start an emergency peritoneal dialysis(all patients were in post-implantation 24 Dialysis began within the first hour and changed to continuous ambulatory peritoneal dialysis 2 weeks later).Kaplan-meier method was used to calculate the survival rate and technical survival rate of the patients.Single factor cox analysis was used to screen out the statistically significant influencing factors.Then a multi-factor COX proportional hazards regression model was used to analyze the independent risks affecting the prognosis of patients with Urgent-start peritoneal dialysis.Results:The average age of 110 patients with eUrgent-start peritoneal dialysis was 50.57±12.38 years,of which 95 patients(65.5%)were<65 years old and 15 patients(13.6%)were>65 years old.According to the primary disease leading to end-stage renal disease,48 cases(43.6%)were diagnosed as chronic glomerulonephritis,35 cases(31.8%)were hypertensive-kidney damage,20 cases were diabetic nephropathy(18.2%),and 7 were other groups.Example(6.4%)According to the Charlson comorbidity index,1 points:1 case(0.9%),2 points:60 cases(54.5%),3 points:32 cases(29.1%),4 points:13 cases(11.8%),5 points:3 cases(2.7%),6 points:1 case(0.9%).As of December 31,2017,the average survival months of 110 Urgent-start peritoneal dialysis patients were 32.94±7.65 months.20 patients(18.2%)died,85 patients(77.3%)continued PD,and 4 patients had HD(3.6%),0 cases(0.0%)of kidney transplants,1 case(0.9%)of lost follow-up.25 cases of withdrawal,total withdrawal rate of 22.7%,The 1-year,2-year,and 3-year survival rates of emergency-starting peritoneal dialysis patients were 90.0%,81,8%,and 81.8%,respectively.The 1-year,2-year,and 3-year technical survivas rates were 89.1%,79.1%,and 79.1%.The COX egression model showed that Charlson comorbidity index,age,hemoglobin,serum albumin,diabetic nephropathy,chronic glomerulonephritis,and hypertensive renal damage were independent risk factors for the survival of Urgent-start peritoneal dialysis patients.Conclusions:1.The primary primary cause of peritoneal dialysis patients in this center is chronic glomerulonephritis,and hemodialysis and death are the main reasons for patients to withdraw from peritoneal dialysis.2.The international definition of Urgent-start peritoneal dialysis is defined as dialysis treatment within 14 days after tube implantation.All patients in this center undergo peritoneal dialysis within 24 hours after tube implantation.The patient's 1-year,2-year,and 3-year survival rates and technical survival rates are roughly the same as those in PD areas where PD are more developed,and higher than some American countries.The key to improving the survival rate of technology is to improve the quality of surgical operations and postoperative care.3.Charlson comorbidity index,age,hemoglobin,serum albumin,diabetic nephropathy,chronic glomerulonephritis,hypertensive renal damage,are independent risk factors for the prognosis of Urgent-start peritoneal dialysis patients..4.The high altitude area is located remotely.The patient is seen late,and the condition is critical.Under the condition of ensuring the quality of peritoneal dialysis catheter implantation,Urgent-start peritoneal dialysis patients,can be considered as a safe choice.However,it is not recommended that patients undergo critical dialysis when the condition is critical and the Charlson comorbidity index is high.Although the technical survival rate is not affected,it will affect the quality of life of patients. |
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