夜间血液透析降低维持性血液透析患者死亡风险

发布时间：2018-05-17 04:12

本文选题：肾透析 + 夜间血液透析　；参考：《第二军医大学学报》2017年08期

【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(P0.01),基线年龄低于CHD组(P0.01),基线透析龄高于CHD组(P0.01),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(P0.01),血磷浓度低于CHD组(P0.05)。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(P0.05)、不伴有糖尿病(P=0.05)以及常规透析3年以上(P0.05)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。
[Abstract]:Objective to compare the risk of death between patients with nocturnal hemodialysis (NHD) and traditional hemodialysis (CHD). Methods from February 2009 to February 2017, 111 patients with NHD and 722 patients with CHD were selected from the long March Hospital of the second military Medical University. The demographic data, clinical features and survival status of the patients were obtained from the hemodialysis data management system. The causes of death and the data of laboratory examination were compared and analyzed. The urea clearance index (KT / V), hemoglobin, blood phosphorus and mortality were compared between the two groups. The mortality risk of the two groups was compared by using the multivariate corrected Cox model. Results the proportion of male patients in NHD group was higher than that in CHD group, the baseline age was lower than that in CHD group (P 0.01), and the baseline dialysis age was higher than that in CHD group (P 0.01). There was no significant difference in complication and laboratory examination. The level of hemoglobin was higher than that of CHD group (P 0.01), and the blood phosphorus concentration was lower than that of CHD group (P 0.05). The mortality rate of NHD group was 3.5 / 100. The mortality rate of CHD group was 6.2 / 100 person-years. After multivariate adjustment for age, dialysis age, sex and complications, the Cox model showed that the risk of death in NHD group was lower than that in CHD group. Subgroup analysis showed that the survival advantage of NHD was more significant in male patients with P0.05, without diabetes mellitus (P0.05) and with routine dialysis for more than 3 years (P0.05). Conclusion NHD is more effective than CHD in clearing solute, improving anemia and calcium and phosphorus metabolism, and reducing the risk of death in patients with maintenance hemodialysis.
【作者单位】：第二军医大学长征医院肾内科解放军肾脏病研究所;
【基金】：国家自然科学基金(81500533) Supported by National Natural Science Foundation of China(81500533)
【分类号】：R692.5

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