残余肾功能对老年血液透析患者生存率的影响
摘要
目的通过回顾性队列研究分析残余肾功能对老年血液透析患者生存预后的影响。方法数据选取自江西省2个血液透析中心2014年1月-2014年12月开始透析并规律随访的老年患者102例,随访数据至2018年12月。利用KaplanMeier方法计算累计生存率,Cox比例风险模型用于分析影响生存预后的危险因素等。结果透析开始时估算肾小球滤过率(eGFR)≥6ml·min~(-1)·(1.73m~2)~(-1)的患者4年生存率显著高于e GFR<6ml·min~(-1)·(1.73m2)~(-1)(62.5%vs 41.9%)。eGFR值对患者的生存预后有预测意义:ROC曲线下面积(AUC)为0.694,灵敏度及特异度分别为83.3%、63.7%。多因素Cox比例风险分析示eGFR<6ml·min~(-1)·(1.73m~2)~(-1)患者死亡风险明显增加(RR=1.936,P=0.013)。结论开始透析时残余肾功能差是影响老年血液透析患者预后的独立危险因素。
引文
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[2]Interplay of volume,blood pressure,organ ischemia,residual renal function,and diet:certainties and uncertainties with dialytic management[J].Semin Dial,2017,30(5):420-429.
[3]Brener ZZ,Kotanko P,Thijssen S,et al.Clinical benefit of preserving residual renal function in dialysis patients:an update for clinicians[J].Am J Med Sci,2010,339(5):453-456.
[4]张莉,鄢艳,杨柳,等.维持性血液透析患者透析充分性相关因素分析[J].江西医药,2014,49(9):799-803.
[5]唐琦,史浩,王伟铭,等.三种肾小球滤过率检测方法与99m TcDTPA[J].中华肾脏病杂志,2005,21(10):589-592.
[6]Babak AV,Peter MO,Richard RB,et al.Prognostic implications of left ventricular hypertrophy[J].Am Heart J,2001,141(3):334-341.
[7]Viaene L,Bammens B,Meijers BK,et al.Residual renal function is an independent determinant of serum FGF-23 levels in dialysis patients[J].Nephrol Dial Transplant,2012,27(5):2017-2022.
[8]顾勇.应充分重视和保护透析患者残余肾功能[J].中华肾脏病杂志,2007,23(7):411-412.
[9]Singh P,Germain MJ,Cohen L,et al.The elderly patient on dialysis:geriatric considerations[J].Nephrol Dial Transplant,2014,29(5):990-996.
[10]皇甫珍慧,胡晓舟,王少亭,等.老年维持性血液透析患者钙磷代谢紊乱情况及影响因素[J].中国老年学杂志,2015,35(24):7146-7148.
[11]张郁苒,张政,于青,等.营养风险指数预估老年血液透析患者[J].中华医学杂志,2015,95(46):3741-3745.
[12]National Kidney Foundation.KDOQI Clinical practice guideline for hemorrhoids adequacy:2015 update[J].Am J Kidney Dis,2015,66(5):884-930.
[13]Watanabe Y,Kawanishi H,Suzuki K,et al.Japanese Society for Dialysis Therapy Clinical Guideline for“Maintenance Hemodialysis:Hemodialysis Prescriptions”[J].Ther Apher Dial,2015,19(Suppl 1):93-107.
[14]Shemin D,Bostom A,Laliberty P,et al.Residual renal function and mortallty risk in hemodialysis patients[J].Am J Kidney Dis,2001,38(1):85-90.
[15]朱丽娜,吕文律,滕杰,等.透析开始残余肾功能与维持性透析患者预后的关系[J].中华肾脏病杂志,2012,28(10):757-764.