Diabetes Res Clin Pr：CAPD糖尿病患者的技术生存与非糖尿病患者相似

为了评估在中国南方地区，糖尿病患者持续非卧床腹膜透析（CAPD）的临床结局和影响生存的危险因素。来自中山大学第一附属医院肾内科的余学清教授及其团队进行了一项研究（Clinicaloutcome and risk factors for mortality in Chinese patients with diabetes on peritoneal dialysis: A 5-year clinical cohort study），该研究发现CAPD糖尿病患者的技术生存与非糖尿病患者相似。该研究结果在线发表在4月19日的《糖尿病研究与临床实践》（Diabetes research and clinical practice）杂志上，该杂志的影响因子为2.754。

在这项纵向队列研究中，2006年1月至2009年12月期间，在中山大学第一附属医院腹膜透析中心入选所有使用CAPD作为他们首选肾脏替代治疗方式的患者，并随访至2011年12月。比较临床结局，并分析糖尿病患者死亡率的危险因素。

该研究结果表明，在809例CAPD患者中，189例（23.4%）有糖尿病。死亡审查技术生存在糖尿病患者和非糖尿病患者之间没有显著差异（p＝0.271）。患者1、2、3、和5年生存率在糖尿病患者分别为90%、72%、63%和36%，而在非糖尿病患者分别为95%、92%、87%和73%（p＝0.000）。在CAPD开始时存在心血管疾病（风险比（HR）2.130,95%可信区间（CI）1.199–3.786，p＝0.010）、高龄（HR 1.042,95%CI 1.008–1.078，P＝0.014）、较高的糖化血红蛋白（HR 1.309,95%CI 1.045–1.640，P＝0.019）、较低的血红蛋白（HR 0.978,95%CI 0.964–0.992，P＝0.003）、以及较低的血清白蛋白（HR 0.924,95%CI 0.876–0.976，P＝0.004）是CAPD糖尿病患者死亡率的独立危险因素。

该研究发现，CAPD糖尿病患者的技术生存与非糖尿病患者相似。虽然糖尿病患者有更高的死亡率风险，但这个研究与其他大多数报告相比，患者的生存似乎有所提高。在CAPD开始时，较高的年龄、存在心血管疾病（CVD）、高血糖、贫血和低白蛋白血症影响糖尿病患者的生存。

Clinical outcome and risk factors for mortality in Chinese patients with diabetes on peritoneal dialysis: A 5-year clinical cohort study.
AIMS
We evaluated clinical outcome and risk factors affecting survival in patients with diabetes on continuous ambulatory peritoneal dialysis (CAPD) in Southern China.
METHODS
This longitudinal cohort study enrolled all incident patients who used CAPD as their first renal replacement therapy modality in our center from January 2006 to December 2009 and who were followed until December 2011. Clinical outcomes were compared and risk factors for mortality in patients with diabetes were analyzed.
RESULTS
Of 809 incident CAPD patients, 189 (23.4%) had diabetes. Death-censored technique survival showed no significant difference between patients with and without diabetes (p=0.271). The 1-, 2-, 3- and 5-year patient survival rates were 90%, 72%, 63% and 36% in patients with diabetes and 95%, 92%, 87% and 73% in patients without diabetes, respectively (p=0.000). Presence of cardiovascular disease (CVD) [hazard ratio (HR) 2.130, 95% confidence interval (CI) 1.199-3.786, p=0.010], advanced age (HR 1.042, 95% CI 1.008-1.078, p=0.014), higher glycated hemoglobin (HR 1.309, 95% CI 1.045-1.640, p=0.019), lower hemoglobin (HR 0.978, 95% CI 0.964-0.992, p=0.003) and lower serum albumin (HR 0.924, 95% CI 0.876-0.976, p=0.004) at the initiation of CAPD were independent risk factors of mortality in CAPD patients with diabetes.
CONCLUSIONS
Technique survival in CAPD patients with diabetes was similar to those without diabetes. Although patients with diabetes had higher risk of mortality, the patient survival in our study seems to be improved compared with most other reports. Older age, presence of CVD, hyperglycemia, anemia and hypoalbuminemia at the commencement of CAPD affected survival in patients with diabetes.