终末期肾病新入血液透析患者3个月内死亡危险因素分析

Risk factor analysis of death within the first 3 months of hemodialysis in patients with end stage nephropathy

目的分析终末期肾病(ESRD)新入血液透析患者3个月内死亡的原因,探讨影响血液透析患者3个月内生存的相关危险因素,为提高血液透析患者3个月内生存率提供研究思路。方法纳入2010年1月1日至2013年12月31日期间四川大学华西医院肾脏科所有ESRD新入血液透析患者,随访至2017年3月1日,将所有进入透析后3个月内死亡的患者作为研究组,将所有存活大于3个月患者作为对照组。比较两组患者进入透析时基本情况、实验室检查等,采用Logistic回归模型分析相关危险因素。结果纳入研究的ESRD新入血液透析患者1 268例,随访期死亡438例,基础疾病主要为:慢性肾小球肾炎(50.47%)、糖尿病(23.03%)、高血压病(9.31%)。新入患者死亡高峰在进入透析3个月内出现,共155例,占所有死亡患者的35.4%。3个月内死亡患者基础疾病主要为:糖尿病(32.26%)、慢性肾小球肾炎(23.23%),高血压病(15.48%)。Logistic分析提示进入透析时查尔森合并症指数(Charlson comorbidity index)较高、基础疾病为糖尿病、中性粒细胞比率升高、病程中曾接受连续性血液净化(CRRT)治疗比例更高、红细胞分布宽度增高是新入血液透析患者3月内死亡的危险因素;较高的血清白蛋白与高密度脂蛋白是保护性因素。研究人群中基础疾病为糖尿病患者292例,3月内死亡50例(17.1%),存活超过3个月的242例(82.9%)。Logistic分析提示病程中曾接受CRRT治疗、更高的查尔森合并症指数、中性粒细胞比率更高是基础疾病为糖尿病患者3个月内死亡的危险因素。结论 ESRD新入血液透析患者在开始3个月内死亡风险较高。积极治疗患者的合并症、改善患者低蛋白状况可能有助于提高患者早期生存率。糖尿病是ESRD患者常见原发病因和死亡危险因素之一,值得关注。

Objective To analyze the causes of death within the first 3 months of hemodialysis in patients with end stage nephropathyand to explore the risk factors affecting survival within the first 3 months in hemodialysis patients, so as to provide some potential solutions to improve the survival of hemodialysis patients within the first 3 months.Methods All the patients with end stage nephropathy starting hemodialysis between 1 January 2010 to 31 December 2013 in Department of Nephrology, West China Hospital of Sichuan University were included and followed-up until March 1, 2017. All the patients who died within the first 3 months of hemodialysis were used as the trial group, and all the patients who survived in the first 3 months as the control group. Baseline conditions and laboratory results were compared between the two groups. Logistic regression analysis of the related risk factors was performed.Results A total of 1 268 patients with end stage nephropathy starting hemodialysis were included, of which 438 ones died. Their baseline diseases mainly included chromic glomerulonephritis(50.47%), diabetes(23.03%), hypertension(9.31%). The mortality peak in the patients with new hemodialysis appeared within the first 3 months of hemodialysis, with a total of 155 death cases, accounting for 35.4% of all the died patients. The baseline diseases in the patients who died in the first 3 months of hemodialysis mainly included diabetes(32.26%), chronic glomerulonephritis(23.23%) and hypertension(15.48%). Logistic regression analysis suggested that increased Charlson comorbidity index(CCI), diabetes as a baseline disease, increased neutrophil ratio, elevated red blood cell distribution width, increased proportion of continuous renal replacement therapy(CRRT) received during disease progressionwere risk factors of death within the first 3 months, whereas increased serum albumin and high-density lipoprotein cholesterol were protective factors. In the study population, there were 292 patients with a baseline disease of diabetes, 50 ones with death within the first 3 months(17.1%), and 242 ones with survival for more than 3 months(82.9%). Logistic analysis suggested, CRRT therapy received during disease progression, increased CCI and increased neutrophil ratio were risk factors of death within the first 3 months in the patients with diabetes as a baseline disease. Conclusions The risk for death within the first 3 months of hemodialysis is high in patients with end stage nephropathy. Active treatment of patients’ complications and low protein status may help improve the early survival rate of patients. Diabetes is one of the common primary causes and death risk factors in patients with end stage nephropathy, which deserves attention.