최근 18년간 단일 기관 진료 자료를 바탕으로 분석한 복막투석 환자의 생존율 및 예후 인자 탐색 = Treatment Outcomes and Prognostic Factors for Peritoneal Dialysis Patients Based on Single Center Experience over 18 years

다국어 초록 (Multilingual Abstract)

Purpose : We investigated the survival rate, factors associated with survival, and peritonitis incidence in PD patients who commenced PD at our center since 1990.
Methods : We investigated 670 patients who started PD between January 1990 and June 2007. Data for sex, age, etiology of ESRD, comorbidities, follow-up duration, cause of death, and peritonitis were analyzed. Kaplan-Meier method was used to determine patient survival and technique survival rate.
Results : The most common cause of death was cardiovascular disease, while peritonitis was the main reason for technique failure. The overall incidence of peritonitis between 1995 and 2007 was 0.270 episodes per patient-year, and there was a significant drop of peritonitis rate from 1995-1999 (0.365) to 2000-2007 (0.230). Patient survival after 5 and 10 years was 71.7% and 48.2% respectively. Technique survival after 5 and 10 years was 72.8% and 43.8%. Older age (age 40-59: HR 2.427, p= 0.016; age≥60: HR 7.397, p<0.001), diabetes (HR 1.973, p=0.001), and cardiovascular disease (HR 2.040, p<0.001) were the independent risk factors of mortality, while older age (age≥60: HR 1.791, p=0.025) and higher peritonitis rate (HR 2.361, p<0.001) were the independent risk factors of technique failure.
Conclusion : The patient survival, technique survival and peritonitis incidence of PD patients in our center showed outcomes comparable to other centers worldwide. Older age, diabetes, and cardiovascular disease were associated with lower patient survival, while older age and higher peritonitis rate were associated with higher technique failure.

국문 초록 (Abstract)

목 적 : 복막투석은 말기신부전증의 신대체요법으로 널리 사용되고 있으나, 국내 생존 관련 자료가 부족한 실정이다. 이에 저자들은 1990년 이후 서울대병원에서 시행한 복막투석 환자의 생존 및 복막염 관련 자료를 분석함으로써, 향후 진료와 연구에 기초 자료로 활용하고자 하였다.
방 법 : 1990년 1월 1일부터 2007년 6월 30일 사이에 서울대병원에서 복막투석을 시작한 15세 이상의 환자 가운데, 3개월 이상 복막투석을 시행한 670명을 대상으로, 2007년 12월 31일까지 관찰하였다. 이들의 성별, 나이, 신부전의 원인, 당뇨병, 심혈관 질환, Davies Comorbidity Score, 사망이나 복막투석 중단의 원인, 그리고 복막염에 대한 자료를 분석하였다. 생존율은 Kaplan-Meier 방법으로 분석하였고, 생존율에 영향을 미치는 독립적인 인자들을 구하기 위하여 multivariate Cox proportional hazard model을 이용하였다.
결 과 : 말기신부전증의 원인은 당뇨병이 33.7%로 가장 많았고, 심혈관계 질환은 20.4%에서 동반되었다. 사망 원인을 알 수 있는 58명 중, 심혈관계 질환이 24명 (41.3%), 감염이 20명 (34.4%)이었으며, 복막투석 중단의 원인으로는 복막염이 66.1%로 가장 많았다. 1995년부터 2007년까지 전체 연간 환자당 복막염 발생률은 0.270회였고, 1995년부터 1999년까지 0.365회인 반면, 2000년부터 2007년까지의 발생률은 0.230회로 감소한 것으로 나타났다. 복막염의 원인균은 그람 양성균이 42.6%로 가장 많았고, 그람 음성균이 23.8%, 균이 동정되지 않는 경우는 26.9%를 차지하였다. 평균 생존 기간은 107.5±4.2개월이었고, 5년 환자 생존율은 71.7%, 10년 생존율은 48.2%이었다. 한편, 평균 복막투석 기간은 106.5±4.3개월이었고, 5년 기술 생존율은 72.8%, 10년 기술 생존율은 43.8%였다. 복막투석 환자 사망에 영향을 미치는 독립적인 인자는 당뇨 (HR 1.973, p=0.001), 심혈관 질환 (HR 2.040, p<0.001), 복막투석을 시작할 당시 나이인 것으로 나타났으며, 40세 미만에 비하여 40세 이상 60세 미만의 위험도는 2.427 (p=0.016), 60세 이상의 위험도는 7.397 (p< 0.001)이었다. 한편, 기술 실패에 영향을 미치는 독립적인 인자는 60세 이상의 나이 (HR 1.791, p=0.025)와 0.270회/년보다 높은 복막염 발생률 (HR 2.361, p<0.001)이었다.
결 론 : 서울대병원에서 시행한 복막투석의 환자 및 기술 생존율과 복막염 발생률은 국내외 보고에 비하여 비슷하거나 우수하였고, 당뇨병, 심혈관계 질환, 그리고 복막투석 시작 당시 나이가 환자 생존율에 영향을 미치는 독립적인 인자로 나타났으며, 나이와 복막염 발생률이 기술 생존율에 영향을 미치는 독립적인 인자로 나타났다.

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