Analysis Of Factors Influencing Survival Time Of Single Center Peritoneal Dialysis Patients With Chronic Renal Failure

Objective:Peritoneal dialysis occupies an important and irreplaceable position in the treatment of patients with end-stage renal disease.The relevant factors that affect the survival time of peritoneal dialysis patients are still unclear,and there is no uniform standard for the optimal start time of peritoneal dialysis.Peritoneal dialysis and hemodialysis are often inseparable.Related studies that the temporary blood purification treatments before peritoneal dialysis affect survival are few.Our study summarizes the survival data of single-center peritoneal dialysis patients to provide a theoretical basis for solving the above problems.Method:We selected 476 chronic renal failure patients with clear basic information who underwent peritoneal dialysis catheterization in the Second Affliliated Hospital of Dalian Medical University from September 29,2006 to August 16,2019 using a retrospective research method.The following criteria were excluded:younger than 18 years old,duration of peritoneal dialysis less than 3months,blood purification treatment for more than 2 months before the initial peritoneal dialysis,alternating peritoneal dialysis and hemodialysis treatment,kidney transplantation before peritoneal dialysis.Finally,372 patients were included in the study until July 26,2020.We collected 22 indicators such as age,gender,primary disease,the time from the discovery of renal function impairment to the end of renal disease（t₁）,the time from the end of renal disease to the initiation of peritoneal dialysis（t₂）,urine volume,serum creatinine,BNP（B-type Natriuretic Peptide,BNP）,blood PH value,serum potassium,the survival time and the reason for withdrawal.Patients who had received temporary blood purification treatment before peritoneal dialysis were assigned to group A,and those who had not received temporary blood purification treatment were assigned to group B.Result:1.general information:Among the total 372 patients,the males were in the percentage of 51.9%,and the average age of 60.28±14.22 years.The main primary diseases with clear causes,were followed by diabetes,primary glomerulonephritis,hypertension and the others.There were 72 cases in the group A and 300 cases in the group B.There were statistically significant differences in the average urine volume,hemoglobin,blood urea,serum sodium,and BNP between the two groups（P<0.05）.2.Estimated survival rate:the overall median survival time of peritoneal dialysis patients in our hospital was estimated as 53.49 months by the life table analysis,the survival rates were 92%,78%and 64%in the first,second and third year respectively,the five-year and ten-year were 44%and 12%,the technique survival rates were 88%70%and 55%in the first,second and third year,the five-year,and ten-year were 34%and 8%.The survival rates of the group A were 92%,70%and 44%in the first,second and third year,the five-year and ten-year were 19%and 0%.The survival rates in group B were 92%,80%,70%in the first,second and third year,the five-year and ten-year were 50%and 14%.The difference between A and B group had difference using Log-rank test（P<0.05）.Further analysis found that the effect of blood purification treatment before peritoneal dialysis on survival time was not significant in the early stage（within 1 year）after peritoneal dialysis（x²=3.377,P=0.066）,but after one year（x²=10.633,P=0.001）and after two years（x²=4.295,P=0.038）,the impact on survival time was significant.3.Analysis of influencing factors of survival time:Using the univariate Cox regression analysis of the overall group,blood purification treatment before peritoneal dialysis,age,diabetes,average urine volume,serum creatinine and serum albumin were all risk factors affecting survival rate（P<0.05）.Multivariate Cox regression analysis,after adjusting for age,diabetes,mean urine volume,serum creatinine,and albumin,receiving temporary blood purification treatment before peritoneal dialysis increased the risk of death by 71.1%（HR:1.711,95%CI:1.130～2.590,P=0.011）.For every 1 year increased in age,the risk of death increased by 5.9%（HR:1.059,95%CI:1.043～1.075,P=0.000）;among the primary diseases,the mortality risk of diabetes was increased by 77.5%（HR:1.775,95%CI:1.244～2.532,P=0.020）that of the others;and every 1 g/L increased in baseline serum albumin,the risk of death was decreased by 5.0%（HR:0.950,95%CI:0.971～0.983,P=0.003）.Univariate Cox regression analysis of group B found that age,t₁,diabetes,acidosis,BNP,serum creatinine,and serum albumin were all risk factors affecting survival（P<0.05）.In addition,there was no significance seen in:gender,t₂,hemoglobin,urine volume,fasting blood glucose,blood urea,blood uric acid,e GRF（estimated glomerular filtration rate,e GFR）,serum sodium,serum potassium,serum calcium,serum phosphorus,PTH（Parathyroid hormone,PTH）,WBC（White Blood cell count,WBC）.Finally,in the multivariate Cox regression model of group B,effective predictors of survival time on peritoneal dialysis were age,diabetes,t₁（the time from impaired renal function to end-stage renal disease）and serum albumin.As age increases,the primary disease is diabetes,t1 decreases,baseline serum albumin decreases,and the risk of death increases.Conclusion:Our study shows that the temporary blood purification treatment before peritoneal dialysis,the increase of age,the primary disease of diabetes and the decrease of baseline serum albumin may affect the survival time of patients with end-stage renal disease on peritoneal dialysis,while the baseline e GFR value has no effect on the survival time.Therefore,actively assessing the condition,integrating age and primary disease,actively correcting factors such as inflammation and nutritional status,and avoiding emergency dialysis are important factors to improve the survival time of peritoneal dialysis patients.