慢性肾脏病4—5期非透析患者死亡的危险因素分析

Risk Factors for Death in Patients with Stage 4-5 Non-Dialysis-Dependent Chronic Kidney Disease

目的探讨慢性肾脏病(CKD)4—5期非透析患者死亡的主要原因、临床特点及其危险因素。方法收集萍乡市人民医院2010年5月至2013年5月201例CKD4—5期非透析患者的一般资料,其中CKD4期125例,CKD5期76例。对CKD4—5期非透析患者死亡的危险因素进行多因素Logistic回归分析。结果 201例患者中,死亡69例(34.3%),其中CKD4期31例,CKD5期38例。主要死亡原因:心血管疾病21例(30.4%),脑血管疾病18例(26.1%),感染16例(23.2%),其他14例(20.3%)。多因素Logistic回归分析结果显示,低肾小球滤过率(eGFR,OR=0.206,P=0.029)、高C反应蛋白(CRP,OR=3.624,P=0.017)、高血尿酸(OR=2.158,P=0.018)、低白蛋白(OR=0.509,P=0.032)及高血磷(OR=1.479,P=0.021)均为CKD4—5期非透析患者死亡的危险因素。结论 CKD4—5期非透析患者病死率较高,心血管疾病是最常见的死因,低eGFR、高CRP、高血尿酸、低白蛋白水平及高磷血症是患者死亡的独立危险因素。

Objective To investigate the main reasons, clinical characteristics and risk factors for death in patients with stage 4-5 non-dialysis-dependent chronic kidney disease（CKD）. Methods Data of 201 patients with non-dialysis-dependent CKD（125 cases of stage 4 CKD and 76 cases of stage 5 CKD） who were treated in Pingxiang People＇s Hospital between May 2010 and May 2013 were collected. The stage 4-5 non-dialysis-dependent CKD risk factors for death were analyzed u- sing multiple logistic regression model. Results Among the 201 patients, death occurred in 69 （34.3o/oo ,31 cases of stage 4 CKD and 38 cases of stage 5 CKD）. The main causes of death includ- ed cardiovascular disease in 21 patients （30.4 %）, cerebrovascular disease in 18 （26.1%）, infection in 16（23.2%） ,and other diseases in 14（20.3%）. Multiple logistic regression analysis showed that the stage 4-5 non-dialysis-dependent CKD risks of death were associated with low glomerular fil- tration rate（OR = 0. 206, P = 0. 029）, high C-reactive protein level （OR = 3. 624, P〈 0. 017）, high blood uric acid level（OR=2. 158,P=0. 018）,low albumin level（OR=0. 509,P=0. 032） and high blood phosphorus level（OR=1. 479,P=0. 021）. Conclusion The mortality is high among pa tients with stage 4-5 non-dialysis-dependent CKD. Cardiovascular disease is the most common cause of death. Low glomerular filtration rate, high C-reactive protein level, high blood uric acid level,low albumin level and hyperphosphatemia are independent risk factors for death.