【摘要】目的回顾性分析2015～2018 年武汉市维持性血液透析(maintenance hemodialysis，MHD)患者流行病学情况，为提高血液透析质量提供数据支持。方法以武汉市血液透析质量控制中心2015～2018 年登记的患者为研究对象，分析死亡患者的流行病学情况。结果① MHD 患者年度死亡率呈下降趋势(χ2=22.668，P＜0.001)，死亡患者的透析龄呈延长趋势(χ2=18.950，P＜0.001)；②透析1 年内死亡患者比例呈降低趋势(χ2=20.069，P＜0.001)。③死亡患者原发病以糖尿病占比最高(26.4%)，其次为高血压(25.1%)、原发性肾小球肾炎(22.1%)；④死亡原因依次为心血管事件(25.3%)、脑血管事件(15.8%)、感染(5.9%)、消化道出血(3.6%)。⑤中年组(45～59 岁)动静脉内瘘组(arteriovenous fistula, AVF)占比偏高，老年组(≥75 岁)AVF 占比最低(χ2=45.927, P＜0.001)。⑥通路为AVF 的患者中位生存时间40(65, 20)月，明显长于非AVF19(38, 9)月，且2 组患者生存曲线存在明显差异(χ2=104.818, P＜0.001)。结论武汉市MHD 患者年度死亡率呈下降趋势，死亡患者透析龄呈延长趋势，原发病以糖尿病为主，死亡原因以心血管事件为首，通路为AVF的患者生存时间相对更长。
【Abstract】Objective To retrospectively analyze the epidemiology of maintenance hemodialysis (MHD) in Wuhan in the period from 2015 to 2018 in order to provide the supporting data for the improvement of quality control of hemodialysis. Methods Information of the MHD patients registered in the Quality Control System of Dialysis in Wuhan from 2015 to 2018 was retrospectively studied. Age, sex, dialysis age, primary disease, vascular access pathway and cause of death of the patients were analyzed. Results ①The decrease tendency of annual mortality was present in the MHD patients (χ2=22.668，P＜0.001), and
their dialysis age became longer (χ2=18.950, P＜0.001). ②Proportion of the MHD patients died in the first dialysis year became less (χ2=20.069, P＜0.001). ③Diabetes accounted for the highest proportion of primary diseases in death cases (26.4% ), followed by hypertension (25.1% ) and primary glomerulonephritis (22.1%). ④The cause of death was cardiovascular events (25.3%), cerebrovascular events (15.8%), infection (5.9%) and gastrointestinal bleeding (3.6%). ⑤The proportion ofAVF in the middlEaged group (45～59 years old) was significantly higher than that in other age groups, and the proportion ofAVF in the elderly group was the lowest (χ2=45.927, P＜0.001). ⑥ The median survival time ofAVF patients was 40 (65, 20) months, significantly longer than that of 19 (38,9) months in non-AVF patients (χ2=104.818, P＜0.001). Conclusion The annual mortality
rate of MHD patients inWuhan city was decreasing. In the death MHD patients, dialysis age became longer, the most important primary disease was diabetes, the most important cause of death was cardiovascular events, and the survival time was relatively longer inMHDpatients withAVF.
[1] Zou Y, Hong D, He Q, et al. Epidemiology investigation and analysis of patients with hemodialysis in Sichuan province of China[J]. Ren Fail, 2019,41(1):644-649.
[2] Zhang L, Zhao M H, Zuo L, et al. China Kidney Disease Network (CK-NET) 2015 Annual Data Report[J]. Kidney Int Suppl (2011), 2019,9(1):e1-e81.
[3] Wang F, Yang C, Long J, et al. Executive summary for the 2015 Annual Data Report of the China Kidney Disease Network (CK-NET)[J]. Kidney Int, 2019,95(3):501-505.
[4] Hattori M, Sako M, Kaneko T, et al. End-stage renal disease in Japanese children: a nationwide survey during 2006-2011[J]. Clin Exp Nephrol, 2015,19(5):933-938.
[5] Foley R N, Sexton D J, Reule S, et al. End-stage renal disease attributed to acute tubular necrosis in the United States, 2001-2010[J]. Am J Nephrol, 2015,41(1):1-6.
[6] Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey[J]. Lancet, 2012,379(9818):815-822.
[7] Hsu C Y, Vittinghoff E, Lin F, et al. The incidence of end-stage renal disease is increasing faster than the prevalence of chronic renal insufficiency[J]. Ann Intern Med, 2004,141(2):95-101.
[8] Wakasugi M, Kazama J J, Yamamoto S, et al. Cause-specific excess mortality among dialysis patients: comparison with the general population in Japan[J]. Ther Apher Dial, 2013,17(3):298-304.
[9] Roberts M A, Polkinghorne K R, McDonald S P, et al. Secular trends in cardiovascular mortality rates of patients receiving dialysis compared with the general population[J]. Am J Kidney Dis, 2011,58(1):64-72.
[10] Saran R, Li Y, Robinson B, et al. US Renal Data System 2014 Annual Data Report: Epidemiology of Kidney Disease in the United States[J]. Am J Kidney Dis, 2015,66(1 Suppl 1):S1-S305.
[11] 邹杨, 洪大情, 蒲蕾, 等. 四川省血液透析死亡患者的流行病学调查(2011年～2016年)[J]. 肾脏病与透析肾移植杂志, 2018,27(03):225-228.
[12] 赵新菊, 王琰, 甘良英, 等. 北京市新增维持性血液透析患者的人口统计学及病因构成的变迁[J]. 中国血液净化, 2014,13(03):185-189.
[13] Janeiro D, Portoles J, Lopez-Sanchez P, et al. How should we analyze and present mortality in our patients?: A multicentre GCDP experience[J]. Nefrologia, 2016,36(2):149-155.
[14] 武晴文, 李昊桐, 赵朵, 等. 山西省维持性血液透析患者预后调查(2013年～2016年)[J]. 肾脏病与透析肾移植杂志, 2019,28(02):119-123.
[15] Collins A J, Foley R N, Herzog C, et al. Excerpts from the US Renal Data System 2009 Annual Data Report[J]. Am J Kidney Dis, 2010,55(1 Suppl 1):S1-S420, A6-A7.
[16] Singhal P, Ren K, Curtis B M, et al. Atypical Noncrescentic Antiglomerular Basement Membrane Disease With Concurrent Thin Basement Membrane Nephropathy[J]. Kidney Int Rep, 2018,3(4):991-996.
[17] 乔勤, 顾波, 马骏. 我国与全球终末期肾脏病的流行现状[J]. 中国血液净化, 2014,13(10):729-732.
[18] Ravani P, Palmer S C, Oliver M J, et al. Associations between hemodialysis access type and clinical outcomes: a systematic review[J]. J Am Soc Nephrol, 2013,24(3):465-473.
[19] 金其庄, 王玉柱, 叶朝阳, 等. 中国血液透析用血管通路专家共识(第2版)[J]. 中国血液净化, 2019,18(06):365-381.
[20] 周宏久, 冯永民, 贾晓燕, 等. 维持性血液透析患者死亡原因及相关影响因素分析[J]. 广东医学院学报, 2016,34(01):48-51.
[21] Saran R, Li Y, Robinson B, et al. US Renal Data System 2015 Annual Data Report: Epidemiology of Kidney Disease in the United States[J]. Am J Kidney Dis, 2016,67(3 Suppl 1):S1-S305.
