| Objective :To explore the clinical characteristics and risk factors of prognosis in patients with different gender of continuous ambulatory peritoneal dialysis(CAPD),and to provide corresponding clinical evaluation and prevention guidance for CAPD patients with different gender.Methods: Retrospective cohort study.Patients of Complete information with end-stage renal disease(ESRD)who proceeded steadily continuous ambulatory peritoneal dialysis(CAPD)treatment for more than 3 months were included in the peritoneal dialysis center of Ningxia Medical University General Hospital from January 1,2008 to December 31,2017.General data of patients,dialysis related data,laboratory indicators,hospitalization follow-up,withdrew follow-up and death follow-up data were collected.The follow-up deadline was December 31,2018.CAPD patients were divided into male and female groups according to gender.Compared the clinical characteristics,hospitalization,withdrew and death of male and female patients.Kaplan-Meier and Cox proportional hazard models were used to analyze survival and related risk factors for different genders.Results:1.Baseline data:(1)A total of 659 CAPD patients were enrolled according to the select and exclusion criteria,including 348 males(52.8%)and 311females(47.2%),an average age of 50.93±14.34 years and a median dialysis age of 34.4(19.8,57.20)months.The primary disease was followed by 355 cases(53.9%)of chronic glomerulonephritis,157 cases(23.8%)of diabetic nephropathy,and 92 cases(14.0%)of hypertensive renal damage.(2)Generalinformation: compared with male group,the female group had lower economic income and education level,higher proportion of chronic glomerulonephritis and lower proportion of diabetic nephropathy,lower BMI,fewer smokers and lower eGFR level(p<0.05).(3)Peritoneal dialysis related data: compared with the male group,the total Kt/v,residual kidney Kt/v,and peritoneal Kt/v were higher in the female group(p<0.05),and the dialysis dose and 24-hour urine volume were less(p< 0.05),the high transport ratio was lower and the high average transport ratio was higher(p<0.0071).(4)Laboratory indicators: compared with the male group,the female group serum potassium,serum phosphorus,serum creatinine,and serum uric acid were lower(p<0.05),blood calcium,triglyceride,cholesterol,and high-density lipoprotein(HDL),low density lipoprotein(LDL)were higher(p <0.05).2.Hospitalization: The median follow-up time was 40.6(23.1,60.2)months,and the hospitalization events were 1194 cases.The hospitalization rates of male and female patients were 58.9% and 56.9%,respectively,and there was no statistical difference.The first three hospitalizations for men and women were pulmonary infection,cardiovascular disease,and peritonitis.Compared with men,the hospitalization rate of women with cardiovascular disease was low,and the rate of cerebrovascular hospitalization was high(p<0.05).3.Prognosis:(1)withdrew: The median follow-up time was 25.8(13.9,46.2)months,during which 336 patients drop out,of which the main reasons for male withdrew were death,conversion hemodialysis and kidney transplantation,while females were mainly dead.Compared with men,women withdrew proportion more due to death,and had fewer hemodialysis(p<0.05).(2)End of death: The median follow-up time was 27.6(14.2,47.7)months,during which 236 deaths occurred.The first three causes of death in men and women were cardiovascular disease,cerebrovascular disease,abandonment treatment.There was no significant difference in the causes of death between male and female(p>0.05).4.Survival data:(1)Survival: The survival rates of CAPD patients at 1 year,3years,5 years,and 10 years,male was 93.2%,72.7%,55.7%,34.9%,and women was 92.5%,76.2%,60.4%,and 18.2%.Kaplan-Meier survival analysis showed that there was no significant difference in all-cause mortality(Log Rank=0.367,p=0.544;Breslow=0.802,p=0.371)and cardiovascular mortality(Log Rank=2.430,p=0.119;Breslow=2.423,p=0.120).(2)Risk factor analysis: age,albumin were an independent risk factor for all-cause mortality in male CAPD patients.HAMILTON depression score,diabetic nephropathy,and albumin were independent risk factors for all-cause mortality in women with CAPD.Conclusion:1.The 1,3,5,and 10 year survival rates of males and females were 93.2%,72.7%,55.7%,34.9%,and 92.5%,76.2%,60.4%,and 18.2%,respectively.There was no significant differences in death between all-cause mortality and cardiovascular disease.2.The rate of withdraw of male CAPD patients was higher than that of females.Compared with females,males had more rate of withdraw due to conversion hemodialysis and fewer rate of withdraw due to deaths.There was no significant difference in the reasons for hospitalization and death between men and women.3.Age and hypoalbuminemia were independent risk factors for the survival of male CAPD patients.HAMILTON depression score,diabetic nephropathy,and hypoalbuminemia were independent risk factors for the survival of women CAPD patients. |
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