DiabetesRes Clin Pr：糖尿病或不影响我国腹透患者生存率

　　中山大学第一附属医院肾内科余学清教授等公布的一项为期5年的临床队列研究表明，在我国接受持续性不卧床腹膜透析（CAPD）的患者中，糖尿病并不显著影响生存率。对于接受CAPD的糖尿病患者，CAPD治疗时高龄、合并心血管疾病、血糖水平高、贫血和低白蛋白血症是影响生存率的因素。（Diabetes Res Clin Pract. 2013年4月22日在线版）

　　该纵向队列研究入选809例接受CAPD的肾病患者，23.4%合并糖尿病。糖尿病患者和非糖尿病患者的死亡审查技术生存率无显著差异（P=0.271）。然而，糖尿病患者1、2、3、5年生存率依次为90%、72%、63%和36%，非糖尿病组则依次为95%、92%、87%和73%（P=0.000）。在启动CAPD时，合并心血管疾病、高龄、糖化血红蛋白水平较高、低白蛋白血症和血红蛋白水平降低均是糖尿病患者死亡的独立预测因素。

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.