腹膜透析病患關於降低心血管疾病風險之治療研究

10.6666/ClinMed.201905_83(5).0050

葛慕慈；黎思源

腹膜透析 ； 心血管疾病

臨床醫學月刊

83卷5期（2019 / 05 / 31）

300 - 308

繁體中文

腹膜透析病患終其一生有非常高的心血管疾病發生率（約佔60%）。澳洲、紐西蘭與美國的數據均指出心血管疾病是腹膜透析病患的主要死因。腹膜透析病患因心血管疾病死亡之發生率，大約為14／100病患－年，在與同年齡、性別的對照組相比，上升10到20倍。如此高的心血管疾病風險，可以歸因於傳統風險因子（如高血壓、血脂異常、肥胖、抽菸、久坐不動的生活方式與胰島素阻抗）、非傳統風險因子（此指腎臟疾病相關風險因子，如貧血、慢性體液累績、發炎、營養不良、高尿酸血症以及腎性骨病變），以及腹膜透析相關風險因子（如透析液、糖化的終端物質、低血鉀、殘餘腎功能以及脫水不良）。針對這些危險因子所作的治療方式，可能可以改善腹膜透析病人的心血管疾病之風險，然而，針對這些治療，目前仍缺乏高證據力的研究證實其療效。本篇文章整理針對腹膜透析心血管疾病的治療與預防方法，並針對國際腹膜透析學會（International Society of Peritoneal Dialysis, ISPD）的主要建議作說明。

1. Asci, G,Ozkahya, M,Duman, S(2006).Volume control associated with better cardiac function in long-term peritoneal dialysis patients.Perit Dial Int,26,85-88.
2. Baigent, C,Keech, A,Kearney, PM(2005).Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins.Lancet,366,1267-1278.
3. Cheung, AK,Sarnak, MJ,Yan, G(2000).Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients.Kidney Int,58,353-362.
4. Cho, Y,Johnson, DW,Craig, JC(2014).Biocompatible dialysis fluids for peritoneal dialysis.Cochrane Database Syst Rev,3,CD007554.
5. Cocchi, R,Degli, Esposti, E,Fabbri, A(1999).Prevalence of hypertension in patients on peritoneal dialysis: results of an Italian multicentre study.Nephrol Dial Transplant,14,1536-1540.
6. Davies, S,Carlsson, O,Simonsen, O(2009).The effects of low-sodium peritoneal dialysis fluids on blood pressure, thirst and volume status.Nephrol Dial Transplant,24,1609-1617.
7. Davies, SJ,Woodrow, G,Donovan, K(2003).Icodextrin improves the fluid status of peritoneal dialysis patients: results of A double-blind randomized controlled trial.J Am Soc Nephrol,14,338-344.
8. Duong, U,Mehrotra, R,Molnar, MZ(2011).Glycemic control and survival in peritoneal dialysis patients with diabetes mellitus.Clin J Am Soc Nephrol,6,1041-1048.
9. Fathi, R,Isbel, N,Short, L(2004).The effect of long-term aggressive lipid lowering on ischemic and atherosclerotic burden in patients with chronic kidney disease.Am J Kidney Dis,43,45-52.
10. Fernandes, NM,Bastos, MG,Franco, MR(2013).Body size and longitudinal body weight changes do not increase mortality in incident peritoneal dialysis patients of the Brazilian peritoneal dialysis multicenter study.Clinics,68,51-58.
11. Habib, AN,Baird, BC,Leypoldt, JK(2006).The association of lipid levels with mortality in patients on chronic peritoneal dialysis.Nephrol Dial Transplant,21,2881-2892.
12. Hou, F,Jiang, J,Chen, J(2012).China collaborative study on dialysis: a multi-centers cohort study on cardiovascular diseases in patients on maintenance dialysis.BMC Nephrol,13,94.
13. Iseki, K,Yamazato, M,Tozawa, M(2002).Hypocholesterolemia is a significant predictor of death in a cohort of chronic hemodialysis patients.Kidney Int,61,1887-1893.
14. Ito, Y,Mizuno, M,Suzuki, Y(2014).Long-term effects of spironolactone in peritoneal dialysis patients.J Am Soc Nephrol,25,1094-1102.
15. Jager, KJ,Merkus, MP,Dekker, FW(1999).Mortality and technique failure in patients starting chronic peritoneal dialysis: results of The Netherlands Cooperative Study on the Adequacy of Dialysis. NECOSAD Study Group.Kidney Int,55,1476-1485.
16. Jiang, N,Qian, J,Lin, A(2008).Initiation of glucose-based peritoneal dialysis is associated with increased prevalence of metabolic syndrome in nondiabetic patients with end-stage renal disease.Blood Purif,26,423-428.
17. Johnson, DW,Dent, H,Hawley, CM(2009).Association of dialysis modality and cardiovascular mortality in incident dialysis patients.Clin J Am Soc Nephrol,4,1620-1628.
18. Li, PK,Chow, KM,Wong, TY(2003).Effects of an angiotensin-converting enzyme inhibitor on residual renal function in patients receiving peritoneal dialysis. A randomized, controlled study.Ann Intern Med,139,105-112.
19. Li, PK,Culleton, BF,Ariza, A(2013).Randomized, controlled trial of glucose-sparing peritoneal dialysis in diabetic patients.J Am Soc Nephrol,24,1889-900.
20. Liebman, SE,Lamontagne, SP,Huang, LS(2011).Smoking in dialysis patients: A systematic review and meta-analysis of mortality and cardiovascular morbidity.Am J Kidney Dis,58,257-265.
21. Locatelli, F,Pisoni, RL,Combe, C(2004).Anaemia in haemodialysis patients of five European countries: association with morbidity and mortality in the Dialysis Outcomes and Practice Patterns Study(DOPPS).Nephrol Dial Transplant,19,121-132.
22. Longenecker, JC,Coresh, J,Klag, MJ(2000).Validation of comorbid conditions on the endstage renal disease medical evidence report: the CHOICE study. Choices for Healthy Outcomes in Caring for ESRD.J Am Soc Nephrol,11,520-529.
23. Lowrie, EG,Lew, NL(1990).Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities.Am J Kidney Dis,15,458-482.
24. Molnar, MZ,Mehrotra, R,Duong, U(2011).Association of hemoglobin and survival in peritoneal dialysis patients.Clin J Am Soc Nephrol,6,1973-1981.
25. O'Lone, EL,Visser, A,Finney, H(2014).Clinical significance f multi-frequency bioimpedance spectroscopy in peritoneal dialysis patients: independent predictor of patient survival.Nephrol Dial Transplant,29,1430-1437.
26. Palmer, SC,Navaneethan, SD,Craig, JC(2013).HMG CoA reductase inhibitors(statins) for dialysis patients.Cochrane Database Syst Rev,9,CD004289.
27. Palmer, SC,Saglimbene, V,Mavridis, D(2014).Erythropoiesis-stimulating agents for anaemia in adults with chronic kidney disease: a network metaanalysis.Cochrane Database Syst Rev,12,CD010590.
28. Qunibi, WY(2015).Dyslipidemia in dialysis patients.Semin Dial,28,345-353.
29. Ramkumar, N,Pappas, LM,Beddhu, S(2005).Effect of body size and body composition on survival in peritoneal dialysis patients.Perit Dial Int,25,461-469.
30. Saran, R,Li, Y,Robinson, B(2015).US Renal Data System 2014 annual data report: epidemiology of kidney disease in the United States.Am J Kidney Dis,66,Svii.S1-Svii.S305.
31. Shen, JI,Saxena, AB,Montez-Rath, ME(2017).Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and cardiovascular outcomes in patients initiating peritoneal dialysis.Nephrol Dial Transplant,32,862-869.
32. Tien, KJ,Lin, ZZ,Chio, CC(2013).Epidemiology and mortality of new-onset diabetes after dialysis: Taiwan national cohort study.Diabetes Care,36,3027-3032.
33. Udayaraj, UP,Steenkamp, R,Caskey, FJ(2009).Blood pressure and mortality risk on peritoneal dialysis.Am J Kidney Dis,53,70-78.
34. Wang, AY,Brimble, KS,Brunier, G,Holt, SG,Jha, V,Johnson, DW(2015).ISPD cardiovascular and metabolic guidelines in adult peritoneal dialysis patients part I - assessment and management of various cardiovascular risk factors.Perit Dial Int,35,379-387.
35. Wanner, C,Tonelli, M(2014).Kidney Disease: Improving Global Outcomes Lipid Guideline Development Work Group M. KDIGO Clinical Practice Guideline for Lipid Management in CKD: summary of recommendation statements and clinical approach to the patient.Kidney Int,85,1303-1309.
36. Workgroup, KD(2005).K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients.Am J Kidney Dis,45,S1-S153.
37. Zucchelli, P,Santoro, A,Zuccala, A.(1988).Genesis and control of hypertension in hemodialysis patients.Semin Nephrol,8,163-168.