1254例维持性血液透析患者长期生存分析

Long-term outcome of 1254 patients with maintenance hemodialysis

目的:了解维持性血液透析(MHD)患者的临床流行病学资料、长期生存率及其影响因素。方法:回顾性分析1974-01-01至2004-12-31在我院确诊为终末期慢性肾脏疾病(ESRD)行血液透析(hemodialysis,HD)治疗超过3个月的MHD患者的性别、年龄、原发病因分布,治疗的转归,长期生存率及其影响因素。结果:①男性占69.70%,女性占30.30%,男/女为1/0.44,开始HD治疗时平均年龄11～88(42.33±13.64)岁,中位年龄40岁,透析时间3月～22.5年。②已明确原发病因的患者中,原发性肾小球疾病700例占68.29%,继发性肾小球疾病193例(19.12%),小管间质性疾病61例(5.95%),先天遗传性疾病58例(5.66%),其他原因者13例(0.98%)。IgA肾病是导致ESRD最常见的原发性肾小球疾病(占53.57%)。继发性肾小球疾病<50岁组前三位病因分别为:狼疮性肾炎(26.31%)、高血压肾损害17例(22.36%)和过敏紫癜性肾炎12例(15.79%);≥50岁组前三位分别为:糖尿病肾病53例(44.16%)、高血压肾损害48例(40.00%)和尿酸性肾病7例(5.83%)。③MHD患者中484例(38.60%)行肾移植,449例(35.80%)转院治疗,改腹膜透析32例(2.55%),目前仍在院HD治疗者153例占(12.20%),死亡136例(占10.85%);④MHD患者的1年存活率为(92.42%),5年存活率为(72.57%),10年存活率为(60.71%),15年存活率为51.

Objective: To analyze the clinical data of patients with maintenance hemodialysis(MHD) in a single blood purification center in China. Methodology:We retrospectively studied the clinical records of 1254 patients with MHD betwee n January 1974 and December 2004. The data on the demographic and epidemiologic aspects of these patients were examined. The age at the start of HD, causes of e nd-stage renal disease (ESRD), period of start HD and dialysis frequency, the su rvival rates and risk factors were analyzed. Results:①The mean age at start of HD was 11 to 88,median 40(42.3±13.6) years old. 6 9.7% of patients in this group were males, 30.30% were females, and the ratio of male to female was 1 to 0.44.② Primary glomerular disease was the most freq uent cause of ESRD, and accounted for 68.3% in our patients, secondary glomerula r disease for 19.1%. In the younger patient (<50y at the start of HD) group, pr imary glomerulonephritis accounted for 80.4% and secondary glomerular disease fo r 9.68%, while in the older group (≥50y at the start of HD), primary glomerulo nephritis only accounted for 28.8% and secondary glomerular disease for 50.0%. IgA nephropathy was the most common primary glomerulonephtitis in those patient s, and accounted for 53.6%. Lupus nephritis (26.3%) was the most common second ary glomerular disease in the younger patients, and diabetic nephropathy (44.2% ) in the older patients.③ Among the 1 254 MHD patients, 38.6% of them recei ved renal transplantation, 35.8% transferred to other hospitals for hemodialysis , 10.9% of them died and the others (12.2%) were still hospitalized in our un its.④ The 1 year, 5 year, 10 year and 15 year survival rate of patients with MHD was 92.4%,72.6%, 60.7%, and 51.4% respectively. Cox proportional hazard analyses showed that risk factors were older age, diabetes, hypertension, insuf ficiency of HD and early period start of HD. Conclusion:In our dialysis center, the majority of the ESRD patients was younger males, wit h primary glomerular disease as the most common cause. In mortality of patients with MHD was lower in 10.9%. The older age, original disease as diabetes and hy pertension, insufficiency of HD and early period start of HD were the risk facto rs.