糖尿病肾病维持性血液透析患者死亡危险因素分析

Analysis on death risk factors in patients with diabetic nephropathy undergoing maintenance hemodialysis

目的探讨影响糖尿病终末期肾病血液透析患者死亡的相关危险因素,为提高糖尿病终末期肾病血液透析患者的生存率提供依据。方法回顾性分析2006年1月1日至2014年10月31日在北京友谊医院血液透析中心行血液透析治疗的384例终末期肾病患者的临床资料,应用COX回归分析糖尿病终末期肾病血液透析患者死亡的相关危险因素。结果终末期肾病患者共384例,其中77例患者死亡。384例患者中,糖尿病肾病65例(16.93%),非糖尿病肾病319例(83.07%)。77例死亡患者中糖尿病肾病24例(31.17%),占糖尿病肾病患者的36.92%;非糖尿病肾病53例(68.83%),占非糖尿病肾病患者的16.61%;COX回归分析提示透析后留存体质量(edOW)、血清钾是糖尿病终末期肾病血液透析患者死亡的危险因素;edOW、性别、血红蛋白、血流量是非糖尿病终末期肾病患者死亡的危险因素。结论血液透析患者应该严格控制透析间期体重的增长,尽可能使edOW<0.1kg;与非糖尿病终末期肾病患者不同,更应关注糖尿病终末期肾病血液透析患者的血钾变化。

Objective To explore the death risk factors in patients with diabetic nephropathy at end stage undergoing maintenance hemodialysis in order to provide the clinical basis for raising survival rate of these patients.Methods The clinical data of 384 patients with end stage renal disease treated in hemodialysis center of this hospital during January,2006 to October,2014 were retrospectively analyzed.The related risk factors of patients with diabetic nephropathy at end stage were analyzed by COX regression analysis.Results Among these 384 patients with end stage renal disease,65（16.93%） of them were suffered from diabetic nephropathy,319（83.07%） suffered from non-diabetic nephropathy,and 77 patients died.Among these fatal patients,24 patients（31.17%） died of diabetic nephropathy,they occupied 36.92% of patients with diabetic nephropathy and 53（68.83%） died of non-diabetic nephropathy,accounted for 16.61%.COX regression analysis showed the death risk factors of patients with end stage diabetic nephropathy including end-dialysis overweight（edOW） and serum potassium,and the death risk factors of patients with non-end stage diabetic nephropathy included edOW,gender,hemoglobin level and amount of blood flow.The end dialysis overweight（edOW） is a common death risk factor of patients with end stage diabetic nephropathy and non-end stage diabetic nephropathy.Conclusion Patients with hemodialysis should strictly control the interdialytic weight gain,as far as possible to make edOW less than 0.1 kg,unlike nondiabetic patients with ESRD,it should pay more attention to the change of blood potassium in diabetic patients with ESRD undergoing hemodialysis.