中国腹透发展现状与挑战课件

中国腹透发展现状与挑战余学清中山大学附属第一医院中国腹透发展现状中国腹透未来发展内容提要广州CKD的患病率:12.1%北京CKD的患病率:11.3%上海CKD的患病率:11.8%郑州CKD的患病率:13.5%ChenW,…YuXQ.etal.NDT2009;24:1205-12ZhangL,…WangH.etal.AJKD,2008;51(3):373-84ChenN,…FanQ.etal.NDT2009;24:2117-23LiuZS,….etal.ChinJofNephrol.2008;24(8):524CKD是中国重要的公共健康问题中国腹膜透析的需求增加人口数量激增，特别是老年群体比例增加CKD患病率高,越来越多的ESRD患者随着经济的发展，医疗保障覆盖更多透析患者有限的资源和基础设施（空间，设备，技术人员）家庭透析逐渐普及和接受腹膜透析在中国的优势安全，方便以及容易掌握有益于远离透析中心居住的患者中国大多数人民居住在农村大部分县级医院没有血液透析设备适合患有具传染性疾病的患者ESRD患者：100多万HD：20万PD：2.3万中国透析登记资料中国不同透析方式现状2006—2010中国腹透病人数*年份20062007200820092010病人数量10000～1200013000～1500016000～1800019000～2100021000～23000*由于目前尚未得到全国腹透病人的数据，此数据仅为百特工作人员的推测数据中国腹透的发展情况卫生部腹膜透析专家组会议腹膜透析数量与腹透质量同步提高腹透临床和腹透科研齐头并进不同级别医院腹透中心共同发展中国腹透未来发展的方向不可调控的危险因素可调控的危险因素年龄残余肾功能(RRF)性别腹膜功能人种/种族感染：腹膜炎糖尿病透析中心规模ESRD病因病人教育遗传JessicaKendrickandIsaacTeitelbaum,ClinJAmSocNephrol5:1123-1131,2010影响患者生存率的因素中心规模>50

与<50比较，腹透病人临床预后较好HD=hemodialysis;pt-yr=patient-year;RH=relativehazard;CI=confidenceinterval;ref.=referencevaluea

p<0.05bDemographics:age,sex,andrace;Clinical:IndexofCoexistentDiseasescore,diabeticstatus,andbodymassindex;Laboratory:albuminandcreatinineLauraal:PDI,Vol.29,pp.285–291中心规模与腹透患者临床预后密切相关退出率DOR%治疗持续时间TOT（月）BigisBeautifulinPD!-Prof.PeterBlake*百特中国数据腹透中心的规模与治疗质量成正相关*腹透临床和腹透科研齐头并进中国腹透未来发展的方向2012.2.311009RapidincreaseinPDpatientnumberatSYSUTechniqueSurvivalforPrevalentPatientsn12mo36mo60moAge＜64ys37799±0.00%96±0.01%86±0.03%Age≥65ys13197±0.03%88±0.05%80±0.03%Total50899±0.02%94±0.03%85±0.06%DatafromSYSUPDregistrationsystemKPIApproachinSYSU2010IndicatorsKPIApproach%Hemoglobin(110-130g)≥70%65%SerumPhosphate(≤1.78mmol/L)≥70%66%WeeklyKt/V≥1.7≥90%91%SBP105-140mmHg≥70%73%PeritonitisRate≥1:301:76ExitInfectionRate≥1:501:87TechnicalSurvival(1year)≥85%98%CatheterSurvival(1year)≥80%94%Johnson,DW,etal.ISPDACM2010,8:2-3TheRegulatingMechanismofTGF-β/SmadsonEMTWangXY,…YuXQ*.BiochimBiophysActa.2008,1782:51-59.NieJ,…YuXQ*.BiochimBiophysActa.2009;1792:122-31.

MaoH,…YuXQ*.AmJPhysiol-RenalPhysiol.2008;295(1):F202-14.ZhangHY,…YuXQ*.Nephrology.2009;14(3):302-10ZhouY,…YuXQ*.JASN2010;21:598-609ZhuFX,etal.AmJPathol2010;176:650-9.ZhouQ,etal.JBiolChem.2010;285(51):40019-27Smad4CellmembraneNucleusEMTandFibrosisSmad7TFIIISmad2/3TGF-βpSmad2/3HSP72HSP72ClinicalResearchPrograminPDPreservationofPeritonealfunctionPreservationofresidualrenalfunctionPreventionofCVDinPDpatientsBio-makerfortheearlydiagnosisSatelliteCenterforoutofGuangzhouAnExcellentPDTeam不同地区腹透中心共同发展中国腹透未来发展的一些思考HigherdropoutofPDpatientsinSuburbanPatientNo’sPercentageGuangzhou20239.6%OutofGuangzhou30860.4%Total510100%2008.6.Satellitecenter●★★★★★★★★★★★★27doctorsandnursestrainedinourcenterPDsatelliteCenterPrograminGuangzhouThisprogramwassupportedbytheBaxterClinicalEvidenceCouncil(CEC)grant2008BackgroundforPDsatellitecenter50%patientsneedtogotothedifferentareasinGuangdongprovinceforfollowupThereexistsomeproblemsinthoseregionsSmallscaleandhaven’thadaPDteamPoorPDtechniqueandcentermanagementWeak/poortraining,teachingandfollowupprogramHighperitonitisanddropoutrates,poorpatientsurvivalPurposeoftheprogramToestablishadvancedPDsatellitecentersinGuangdongprovincewithwelleducationandtrainingsystemUsingstandardPDprograminpatient’straining,educationandfollow-upproceduresTosetupagoodmodeltoimprovePDoutcome(i.e.patientandtechnicalsurvival)andQOIPDSatelliteCenterRunningProcedureThePDcenterinSunYat-SenUniversityinitiatedandrunningthisprogramEachsatellitePDcenterneedtohavefull-timePDdoctorandnurses,and,usethesameprogramfortraining,education,followupandforalltreatmentprotocols.AllthecentersreporttheirworktotheSunYat-senuniversityPDcentereverymonthandjointheregularmeetingevery6monthsRegularsiteobservationandfeedbackourcommentsRegulardatacollectionIncidencepatientsandcausesPDadequacyandanalysisNutritionalstatusComplicationincidencePatient-andtechnical-survivalPatientdrop-outsandreasonsSummaryofthesatellitePDcenter12PDcentersjoinedthisprogram26doctorsand32nursestrainedPDptsincreasedfrom1010to1860ClinicaldataofPDpatients20072009BloodPressureNormalBP38.4%39.3hypotension1.1%1.7%Mild-mediumhypertension52.5%51.8%Serioushypertension10.3%7.1%SerumAlbumin<35g/L28.8%25.0%≥35g/L71.2%75.0%Kt/V>2.041.0%40.6%1.7-2.032.1%34.8%<1.727.2%24.6%SomeIndexeshaveshownimprovementIndex20072009Patientsurvivor(1year)82.0%84.2%TechnicalSurvivor(1year)88.7%93.0%Patientdropout28.217.6TOT17.818.1Peritonitisrate44.343.8ThefutureplanforthisprogramExpandourexperienceinthePDsatellitecenterProgramToconductmoremulti-centericclinicalresearchinChina.Toexpandthispr