中國腹透發展現狀與挑戰余學清中山大學附屬第一醫院中國腹透發展現狀中國腹透未來發展內容提要廣州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%鄭州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是中國重要的公共健康問題中國腹膜透析的需求增加人口數量激增，特別是老年群體比例增加CKD患病率高,越來越多的ESRD患者隨著經濟的發展，醫療保障覆蓋更多透析患者有限的資源和基礎設施（空間，設備，技術人員）家庭透析逐漸普及和接受腹膜透析在中國的優勢安全，方便以及容易掌握有益于遠離透析中心居住的患者中國大多數人民居住在農村大部分縣級醫院沒有血液透析設備適合患有具傳染性疾病的患者ESRD患者：100多萬HD：20萬PD：2.3萬中國透析登記資料中國不同透析方式現狀2006—2010中國腹透病人數*年份20062007200820092010病人數量10000～1200013000～1500016000～1800019000～2100021000～23000*由于目前尚未得到全國腹透病人的數據，此數據僅為百特工作人員的推測數據中國腹透的發展情況衛生部腹膜透析專家組會議腹膜透析數量與腹透質量同步提高腹透臨床和腹透科研齊頭并進不同級別醫院腹透中心共同發展中國腹透未來發展的方向不可調控的危險因素可調控的危險因素年齡殘余腎功能(RRF)性別腹膜功能人種/種族感染：腹膜炎糖尿病透析中心規模ESRD病因病人教育遺傳JessicaKendrickandIsaacTeitelbaum,ClinJAmSocNephrol5:1123-1131,2010影響患者生存率的因素中心規模>50

與<50比較，腹透病人臨床預后較好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中心規模與腹透患者臨床預后密切相關退出率DOR%治療持續時間TOT（月）BigisBeautifulinPD!-Prof.PeterBlake*百特中國數據腹透中心的規模與治療質量成正相關*腹透臨床和腹透科研齊頭并進中國腹透未來發展的方向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不同地區腹透中心共同發展中國腹透未來發展的一些思考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