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  • 汤晓静,叶朝阳,戴兵,梅长林,郁胜强.夜间血液透析降低维持性血液透析患者死亡风险[J].第二军医大学学报,2017,38(8):967-972    [点击复制]
  • TANG Xiao-jing,YE Chao-yang,DAI Bing,MEI Chang-lin,YU Sheng-qiang.Nocturnal hemodialysis reducing mortality risk of maintenance hemodialysis patients[J].第二军医大学学报,2017,38(8):967-972   [点击复制]
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夜间血液透析降低维持性血液透析患者死亡风险
汤晓静,叶朝阳,戴兵,梅长林,郁胜强*
0
(第二军医大学长征医院肾内科, 解放军肾脏病研究所, 上海 200003
*通信作者)
摘要:
目的 比较夜间血液透析(NHD)与传统血液透析(CHD)患者之间死亡风险的差异并探讨其影响因素。方法 选择2009年2月至2017年2月第二军医大学长征医院收治的111例NHD及722例CHD患者,从血液透析数据管理系统获取患者的人口学资料、临床特征、生存状态、死亡原因及实验室检查数据,比较分析两组的尿素清除指数(Kt/V)、血红蛋白、血磷、死亡率等指标,采用多因素校正后的Cox模型比较两组患者死亡风险的差异。结果 NHD组男性患者比例更高(P<0.01),基线年龄低于CHD组(P<0.01),基线透析龄高于CHD组(P<0.01),原发病、合并症及实验室检查方面差异无统计学意义。NHD组的Kt/V、血红蛋白水平高于CHD组(P<0.01),血磷浓度低于CHD组(P<0.05)。NHD组死亡率为3.5/100人年,CHD组死亡率为6.2/100人年。经过年龄、透析龄、性别、合并症等多因素校正后,Cox模型显示NHD组患者的死亡风险低于CHD组(HR=0.67,95%CI:0.39~1.00,P=0.05)。亚组分析显示NHD在男性(P<0.05)、不伴有糖尿病(P=0.05)以及常规透析3年以上(P<0.05)的患者中生存优势更为明显。结论 NHD比CHD更能有效清除溶质,改善贫血和钙磷代谢,降低维持性血透患者的死亡风险。
关键词:  肾透析  夜间血液透析  存活率分析  死亡率  死亡原因
DOI:10.16781/j.0258-879x.2017.08.0967
投稿时间:2017-04-20最后修改时间:2017-06-01
基金项目:国家自然科学基金(81500533).
Nocturnal hemodialysis reducing mortality risk of maintenance hemodialysis patients
TANG Xiao-jing,YE Chao-yang,DAI Bing,MEI Chang-lin,YU Sheng-qiang*
(Department of Nephrology, Kidney Institute of PLA, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
*Corresponding author)
Abstract:
Objective To compare the difference of mortality risk between patients undergoing nocturnal hemodialysis (NHD) and conventional hemodialysis (CHD) and to explore the related factors of mortality. Methods The study cohort comprised the maintenance hemodialysis patients receiving either NHD (n=111) or CHD (n=722) in Changzheng Hospital of Second Military Medical University from Feb. 2009 to Feb. 2017. The demographic information, clinical characteristics, survival status, causes of death and laboratory examination indexes were obtained from hemodialysis management system. The urea clearance index (Kt/V), hemoglobin, blood phosphorus concentration and mortality were compared between NHD and CHD patients. The multivariate-adjusted Cox model was used to analyze the mortality risk of all patients. Results Compared with the patients receiving CHD, the proportion of male was more in the NHD group, and the baseline age was younger (P<0.01) and baseline dialysis vintage was longer (P<0.01). There was no significant difference in incidences of primary disease and comorbidities, or laboratory examination results. Compared with the CHD group, the levels of Kt/V and hemoglobin in the NHD group were significantly higher (P<0.01), and the blood phosphorus concentration was significantly lower (P<0.05). Mortality in the NHD and CHD groups was 3.5 per 100 patients-years and 6.2 per 100 patients-years, respectively. After the adjustment by baseline age, dialysis vintage, gender, and comorbidities, Cox model analysis showed that the mortality risk in the NHD group was lower than in the CHD group (HR=0.67, 95%CI:0.39-1.00, P=0.05). Subgroup analysis showed NHD was of more survival benefit for male (P<0.05), non-diabetic patients (P=0.05) and patients with conventional dialysis vintage >3 years (P<0.05). Conclusion NHD can effectively increase the solute clearance, improve anemia and calcium and phosphate metabolism, and thus reduce the mortality risk of maintenance hemodialysis patients.
Key words:  renal dialysis  nocturnal hemodialysis  survival analysis  mortality  cause of death