维持性血液透析患者超滤率与心血管事件死亡的相关性

Relationship between ultrafiltration rate and cardiovascular death in maintenance hemodialysis patients

目的探讨血液透析超滤率（ultrafiltrationrate，UFR）与维持性血液透析患者心血管事件死亡的关系。方法回顾性分析2010年1月至2015年12月间浙江大学医学院肾脏病中心接受血液透析治疗超过3个月、年龄在18到80周岁之间的维持性血液透析患者，随访至2017年4月，以三分位数法分为高UFR（UFR≥10．95ml·h^-1·kg^-1）、中UFR（7．82≤UFR〈10．95ml·h^-1·kg^-1）和低UFR（UFR〈7．82ml·h^-1·kg^-1）3组，采用Kaplan-Meier曲线（Log．rank检验）、Cox回归分析法分析UFR与患者心血管事件死亡的相关性，以卡方检验比较不同超滤率组患者心血管事件死亡的差异。结果共纳入2184例患者，年龄为（53．39±16．47）岁，男性占62．7％，UFR（8．88±3．05）ml·h^-1·kg^-1。7年间患者总死亡168例，其中心血管事件死亡58例（34．5％）。卡方检验提示高、中、低UFR组患者死亡原因差异有统计学意义（x2=12．584，P〈0．01），高UFR组心血管事件病死率显著高于低UFR组（x2=10．861，P=O．010）和中UFR组（x2=4．671，P=0．031）。Kaplan．Meier生存分析表明，3组UFR者生存率差异有统计学意义（x2=23．394，P〈0．001），高UFR组长期生存率较低。Cox多因素回归分析表明，高UFR（UFR~〉10．95ml·h^-1·kg^-1）、高龄（〉60岁）和低左室射血分数（LVEF，≤50％）是患者心血管事件死亡的独立危险因素。结论高UFR、高龄和低LVEF是维持性血液透析患者心血管事件死亡的独立危险因素，保持较低UFR水平有利于减少维持性血液透析患者的心血管事件死亡。

Objective To investigate the relationship between uhrafihration rate （UFR） and cardiovascular death in maintenance hemodialysis patients. Methods This retrospective study observed adult hemodialysis patients treated in Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University during January 2010 to December 2015 and the follow- up were finished at April 2017. Patients were averagely divided into 3 groups according to their UFR. Their clinic characteristics were collected, the survival rate and death related factors were analyzed by Kaplan-Meier （Log-rank test） method and Logistic regression. Results Totally 2184 patients （male 1370, 62.7%） were enrolled, the age was 53.39±16.47. The UFR was （8.88±3.05） ml·h^-1·kg^-1. During the 7 years＂ follow-up, 168 patients died, of whom 58 cases （34.5%） died due to the cardiovascular events. Chi-square test showed that there were significant differences in death causes among the high, middle and low UFR group （x=12.584, P 〈 0.01）, and the mortality rate of cardiovascular events inhigh UFR group was significantly higher than that in low （x2=10.861, P= 0.010） and middle UFR group （X2=4.671, P=0.031）. Kaplan-Meier survival curve showed that the difference of the survival rates in the 3 groups was statistically significant （Log-rank test x2=23.394, P 〈 0.001）. Cox regression analysis showed that high UFR （UFR≥ 10.95 ml·h^-1·kg^-1）, old age （〉 60 years old）, and low left ventricular ejection fraction （LVEF, ≤50%） were independent risk factors of cardiovascular death. Conclusions High UFR level, old age and low LVEF are independent risk factors of cardiovascular death in hemodialysis patients. Maintaining low UFR level is beneficial to reduce cardiovascular mortality in hemodialysis patients.