2009-2018年美国腹膜透析患者预后趋势

IF 8.2 1区医学 Q1 UROLOGY & NEPHROLOGY

American Journal of Kidney Diseases Pub Date : 2025-07-09 DOI:10.1053/j.ajkd.2025.06.007

Christopher Knapp , Shuling Li , Chuanyu Kou , David T. Gilbertson , James B. Wetmore , Allyson Hart , Kirsten L. Johansen

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引用次数: 0

摘要

理由与目的自2009年以来，腹膜透析（PD）的使用有所增加。我们试图评估不同人口群体结果的历史差异是如何随时间变化的。研究设计回顾性队列研究。背景和参与者：2009年至2018年在美国启动PD的患者在美国肾脏数据系统（USRDS）中代表。暴露：患者年龄、种族/民族、城市或农村居住地、肥胖状况和邻里剥夺程度。结果：透析开始后1年和2年的死亡率和转向中心血液透析（HD）。分析方法估计每个年度队列的累积事件发生率。使用Cox比例风险模型（死亡率）和Fine-Gray模型（转换为HD）评估时间趋势。结果共纳入101640例PD患者，其中38.1%年龄≥65岁，57.5%为白人。PD发病一年后的总死亡率从2009年的11.0%下降到2018年的8.4%，每两个研究年的风险降低3%（风险比[HR] 0.97, 95%可信区间[CI] 0.96-0.99）。PD开始一年后转为中心内HD的概率从2009年的17.8%下降到2018年的15.1%，每两个研究年的风险降低2% （HR 0.98, 95% CI, 0.97-1.00）。75岁以上的患者随着时间的推移转化为HD的几率并没有降低（HR 1.02, 95% CI 0.99-1.05，年龄相互作用的p = 0.02）。总的来说，PD开始后两年内转化为HD的风险没有改善。与城市或农村居住、种族/民族、肥胖或邻里剥夺程度无关，死亡率和转化为HD的危险也发生了类似的变化。医学合并症数据不完整。结论在2009年至2020年期间，无论患者人口统计学因素如何，PD患者的死亡率都有所改善。随着随访时间的延长，转换为中心HD的危险改善较少，减弱。

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Trends in Outcomes Among Patients Initiating Peritoneal Dialysis in the United States, 2009-2018

Rationale & Objective

Peritoneal dialysis (PD) use has increased since 2009. We sought to evaluate how historic disparities in outcomes across different demographic groups have changed over time.

Study Design

Retrospective cohort study.

Setting & Participants

Patients initiating PD from 2009 to 2018 in the United States represented in the US Renal Data Systems (USRDS).

Exposure

Patient age group, race and ethnicity, urban or rural residence, obesity status, and level of neighborhood deprivation.

Outcome

Mortality and conversion to in-center hemodialysis (HD) in 1 and 2 years after dialysis initiation.

Analytical Approach

The cumulative incidence of events was estimated for each yearly cohort. Temporal trends were evaluated using Cox proportional hazards models (mortality) and Fine-Gray models (conversion to HD).

Results

The study included 101,640 incident PD patients, of whom 38.1% were aged ≥65 years, and 57.5% were White. The overall mortality 1 year after PD initiation decreased from 11.0% in 2009 to 8.4% in 2018, and the hazard decreased by 3% per 2 study years (HR, 0.97 [95% CI, 0.96-0.99]). The probability of conversion to in-center HD 1 year after PD initiation decreased from 17.8% in 2009 to 15.1% in 2018, and the hazard decreased by 2% per 2 study years (HR, 0.98 [95% CI, 0.97-1.00]). Patients over 75 years old did not experience lower conversion to HD over time (HR, 1.02 [95% CI, 0.99-1.05], P for age interaction = 0.02). Overall, the hazard of conversion to HD in the 2 years after PD initiation did not improve. Hazards of mortality and conversion to HD changed similarly, regardless of urban or rural residence, race and ethnicity, obesity, or level of neighborhood deprivation.

Limitations

Incomplete data on medical comorbidities.

Conclusions

The rate of mortality improved for incident PD patients regardless of patient demographic factors over the period 2009 to 2020. Hazards of conversion to in-center HD improved less and attenuated with longer follow-up.

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来源期刊

American Journal of Kidney Diseases 医学-泌尿学与肾脏学

CiteScore

20.40

自引率

2.30%

发文量

732

审稿时长

3-8 weeks

期刊介绍： The American Journal of Kidney Diseases (AJKD), the National Kidney Foundation's official journal, is globally recognized for its leadership in clinical nephrology content. Monthly, AJKD publishes original investigations on kidney diseases, hypertension, dialysis therapies, and kidney transplantation. Rigorous peer-review, statistical scrutiny, and a structured format characterize the publication process. Each issue includes case reports unveiling new diseases and potential therapeutic strategies.