北京市血液透析患者的透析时机的变迁

The trend of the timing at which hemodialysis initiated in Beijing area

目的 对于终末期肾脏病患者,在何时开始透析治疗仍然是一个未能得到共识的热门问题.本课题旨在研究北京市的终末期肾脏病患者的透析时机是如何变迁的. 方法 所有资料均来自北京市血液净化质量控制中心的2012年度报告.入选条件：①开始透析时间在2007年1月1日～2012年12月31日的所有终末期肾脏病患者;②开始透析前90天内或进入透析后90天内有血肌酐的化验结果.根据进入透析时的血肌酐水平,通过CKD-EPI公式计算得到eGFR,并以此评估透析时机.根据eGFR水平将透析时机分为3组,分别为Group 1[eGFR：0～4.9 ml/（min· 1.73m^2）]、Group 2[eGFR：5.0～9.9 ml/（min·1.73m^2）]和Group 3[eGFR：10 ml/（min·1.73m^2）及以上]. 结果 共有7 200例患者符合入选条件,其平均年龄为57.5±16.0岁,男性占56.3％.自2007年至2012年间,分别有341、682、1137、1577、1886、1577例患者开始透析治疗.比较历年的eGFR分组情况,自2007～2010年,Group 3组的患者比例逐渐升高,至最高峰20.7％,之后下降至2012年的15.6％.Group 2组的患者比例在2012年为最高峰,52.8％.无论哪一个年度,均有一半左右的患者进入透析治疗时的eGFR在5～10 ml/（min· 1.73m^2）范围;低于5 ml/（min·1.73m^2）进入透析的患者比例约为1/3,明显高于美国USRDS的统计结果. 结论 北京市终末期肾病患者人数近些年仍有持续的增长,透析时机比美国USRDS的报道明显偏晚.

Objective It is still a controversial issue about the optimal time of initiation of dialysis for end stage renal disease （ESRD） patients.The aim of this study was to examine the trend of the time at which dialysis initiated for ESRD patients in recent years in Beijing area.Methods The data of all patients were obtained from the annual report of Beijing Blood Purification Quality Control and Improvement Center （BJB-PQCIC） registry database.The patients who initiated hemodialysis between 2007 and 2012 were enrolled.Those who did not have the result of serum creatinine in the 90 days before or after dialysis initiation were excluded.eGFR was calculated by the CKD-EPI formula.Patients were stratified into three groups,group 1 [（eGFR 0～4.9 ml/（min · 1.73m^2）],group 2 [eGFR 5.0～9.9 ml/（min · 1.73m^2）] and group 3 [（eGFR：〉10 ml/ （min · 1.73m^2）].Results A total of 7,200 patients met the inclusion criteria,with the age of 57.5±16.0 years old and 56.3% males.During the period between 2007 and 2012,341,682,1,137,1,577,1,886 and 1,577 patients initiated hemodialysis annually.From 2007 to 2010,the group 3 percentage gradually increased to 20.7%,and then decreased to 15.6%o in 2012.The peak of group 2 percentage was 52.8% in 2012.About half of the patients started dialysis with the eGFR of 5-10 ml/（min · 1.73m^2）,and one third with the eGFR of 〈5 ml/ mir/l.73rn2 in every year.The group 1 and 2 percentage was higher than that in the United States.Conclusion The number of ESRD patients increased in Beijing in recent years.The timing of dialysis initiation in ESRD patients in Beijing was later than that in the United States.