维持性血液透析患者的长期生存分析

张晓华; 李静; 王利华

doi:10.3969/j.issn.1671-4091.2019.12.005

中国血液净化 >

2019 , Vol. 18 >Issue 12: 826 - 829

DOI: https://doi.org/10.3969/j.issn.1671-4091.2019.12.005

临床研究

维持性血液透析患者的长期生存分析

张晓华 ,
李静 ,
王利华

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1. 山西医科大学第二医院肾内科

收稿日期: 2019-08-06

修回日期: 2019-10-08

网络出版日期: 2019-12-03

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Long-term survival analysis of maintenance hemodialysis patients

ZHANG Xiao-Hua ,
LI Jing ,
WANG Li-Hua

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1Department of Nephrology, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China

Received date: 2019-08-06

Revised date: 2019-10-08

Online published: 2019-12-03

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摘要

【摘要】目的通过对单中心维持性血液透析(maintenance hemodialysis，MHD)患者多个相关性因素进行分析，了解影响血液透析患者长期生存的因素，以期提高MHD 患者的生存率和生存质量。方法回顾分析2010 年1 月～2017 年12 月在山西医科大学第二医院肾内科血液净化中心透析超过3 个月且转归明确的MHD 患者的病历资料，探寻各项指标对MHD 患者生存率的影响。结果共纳入MHD 治疗的终末期肾病患者235 例，其中男性133 例，女性102 例。MHD 患者1 年生存率为93.7%，3 年生存率81.4%，5 年生存率76.2%，10 年生存率16.4%，生存期最长1 例超过252 月。首次透析时高龄、原发病为糖尿病肾病、每周透析频率＜2 次/周、透析前高血磷可增加血液透析患者死亡风险(RR 值分别为1.03, 2.24, 2.34, 1.34；P 值分别为＜0.001，＜0.001，＜0.001，0.034)，而首次透析血管通路为自体内瘘、尿素清除指数(Kt/V)≥1.2、较高血红蛋白及血白蛋白水平可降低血液透析患者死亡风险(RR 值分别为0.78, 0.72, 0.76, 0.61；P 值分别为＜0.001，＜0.001，＜0.001，＜0.001)。结论随着血液透析治疗时间延长，患者的长期生存率逐渐下降。首次血液透析时高龄、原发病为糖尿病肾病、透析前高血磷为透析患者死亡的危险因素，而首次透析血管通路为自体内瘘、透析充分性好、有较高血红蛋白及血白蛋白水平是透析患者预后的保护因素。

关键词： 维持性血液透析; 死亡原因; 生存率; 危险因素; 保护因素

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张晓华 , 李静 , 王利华 . 维持性血液透析患者的长期生存分析[J]. 中国血液净化, 2019 , 18(12) : 826 -829 . DOI: 10.3969/j.issn.1671-4091.2019.12.005

Abstract

【Abstract】Objective Through the analysis of multiple related factors in maintenance hemodialysis (MHD) patients in a single center, the factors affecting long-term survival were evaluated for the improvement of survival rate and quality of life in MHD patients. Methods We retrospectively analyzed clinical records of 235 patients treated with MHD for more than 3 months in the Blood Purification Center, the Second Hospital of Shanxi Medical University between January 2010 and December 2017 to explore the impact of related factors on survival of MHD patients. Results Among the 235 MHD patients, 133 were males and 102 were females. The survival rate was 93.7% in one year, 81.4% in three years, 76.2% in five years and 16.4% in ten years. The longest survival patient lasted MHD for 252 months and still survived well. Older age at the first dialysis (RR=1.03, P＜0.001), diabetic nephropathy (RR=2.24, P＜0.001), dialysis frequency <2 times per week (RR=2.34, P＜0.001) and higher blood phosphorus before dialysis (RR=1.34, P＜0.001) increased the risk of death in MHD patients. Autologous arteriovenous fistula beginning from the first vascular access (RR=0.78, P＜0.001), urea clearance index (Kt/V) >1.2 (RR=0.72, P＜0.001) and higher hemoglobin (RR=0.76, P＜ 0.001) and albumin levels (RR=0.61, P＜0.001) decreased the risk of death in MHD patients. Conclusion As the hemodialysis treatment prolonged, the long-term survival rate declined gradually. Older age at the first dialysis, diabetic nephropathy and high levels of blood phosphorus before dialysis were the risk factors for survival. Autologous arteriovenous fistula used earlier, better dialysis adequacy and higher hemoglobin and albumin levels were the protection factors for survival in MHD patients.

Key words： Maintenance hemodialysis; Cause of death; Survival rate; Risk factor; Protection factor

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