初始透析终末期肾病的患者临床特征分析

Characteristics of Patients with End Stage Renal Disease When Initiating Dialysis

目的:了解复旦大学附属中山医院2000—2008年初始透析的终末期肾病(end stage renal disease,ESRD)患者的临床特征。方法:回顾分析2000—2008年在复旦大学附属中山医院初始透析的ESRD患者的一般资料、ESRD病因、合并症、透析初始时的主要血清生化指标及估算肾小球滤过率(eGFR)。结果:共入组1139例,其中男性591例,女性448例;年龄(53.8±16.9)岁。ESRD病因前3位依次为慢性肾小球肾炎、糖尿病肾病、高血压肾病。透析前82.0%患者合并高血压(151.1±24.5)mm Hg/(87.0±15.1)mmHg;其他合并症依次为糖尿病、心力衰竭、冠心病。患者初始透析时,血红蛋白73.2 g/L,eGFR(5.5±3.2)mL/(min.1.73 m2),血红蛋白、血清白蛋白逐年增高(P<0.05)。结论:慢性肾小球肾炎仍然是ESRD的最主要病因。患者透析前血压控制、贫血、营养状况不理想。临床医师需要加强透析前并发症的治疗和管理,及早做好透析准备,减少透析并发症。

Objective：To investigate the characteristics and annual changes with patients of end stage renal disease （ESRD） who initiated dialysis in the hemodialysis center of Zhongshan Hospital,Fudan University. Methods： An retrospective interview was taken among the ESRD patients who intiated dialysis from 2000 to 2008. Patients＇ basic profiles, primary renal disease of ESRD, complications, laboratory results and estimated glomerular filtration rate（eGFR） were analyzed. Results： A total of 1139 ESRD patients initiated dialysis were enrolled[591 male（60.7%） and 448 female（39.3 %） ], the average age was 53.8 -＋ 16.9 years old （13 to 95 years old）. 57.3 % patients＇ primary renal disease was chronic glomerulonephritis, ESRD due to dia- betes mellitus and hypertension was 12.7% and 11.9%, respectively. There were 82.0% patients complicated with hyperten- sion the mean blood pressure before dialysis was（151.1 ± 24.5）mmHg/（87.0 ± 15.1）mmHg. The mean level of hemoglobin was 73.2 g/L. The level of hemoglobin and serum albumin increased significantly annually （P〈0.05）. The mean eGFR was （5.5 ± 3.2）mL（min · 1.73m2）. Conclusions： Chronic glomerulonephritis is the major cause of ESRD. ESRD patients had poor management in blood pressure, anemia, nutrition before initiating dialysis. Clinical nephrologists should strengthen the man- agement and treatment of ESRD complications. Early preparation for dialysis should be suggested to reduce dialysis complica- tions.