15年间维持性血液透析患者400例病死原因分析

Analysis of the causes of death of 400 patients with maintenance hemodialysis in our hospital during 15 years

目的分析维持性血液透析(MHD)患者的病死原因及危险因素,为提高MHD患者生存质量和生存率提供数据支持。方法选取2006年3月—2020年11月在中日友好医院肾病科血液净化中心接受MHD治疗的患者,其中病死患者400例。收集患者临床资料,分析15年间病死患者的流行病学特征。结果400例MHD病死患者,男219例(54.75%),女181例(45.25%),年龄(70.76±11.86)岁,中位透析时长42.75(3.00,276.98)个月。病死原因前4位分别是:心血管事件131例(32.75%),脑血管事件67例(16.75%),全身多脏器衰竭60例(15.00%),感染56例(14.00%)。糖尿病肾病患者中位透析时长较非糖尿病肾病患者低[35.25(3.00,153.10)个月vs.55.00(3.00,290.00)个月,Z=3.237,P=0.032],而老年透析患者透析后中位生存时间低于非老年透析患者[29.25(3.00,196.03)个月vs.100.75(3.00,312.10)个月,Z=4.375,P=0.014]。COX多因素分析显示,男性、年龄≥60岁、未使用动静脉内瘘、合并糖尿病是MHD患者全因病死的独立危险因素[HR(95%CI)=1.333(1.108~1.586)、2.144(1.651~2.784)、3.125(2.361~3.597)、1.234(1.021~1.491)]。结论心血管事件、脑血管事件、全身多脏器衰竭、感染是MHD患者的主要病死原因。男性、年龄≥60岁、未使用动静脉内瘘、合并糖尿病是MHD患者病死的独立危险因素。

Objective To analyze the causes of death and risk factors of maintenance hemodialysis(MHD)patients,and provide data support for improving the quality of life and survival rate of MHD patients.Methods Selected patients who received MHD treatment at the Blood Purification Center of the Department of Nephrology,China-Japan Friendship Hospital from March 2006 to November 2020,of which 400 patients died.Collect clinical data of patients and analyze the epidemiological characteristics of patients who died during 15 years.Results There were 400 patients who died of MHD,including 219 males(54.75%)and 181 females(45.25%),with an age of(70.76±11.86)years and a median duration of dialysis of 42.75(3.00,276.98)months.The top 4 causes of death were:131 cases of cardiovascular events(32.75%),67 cases(16.75%)of cerebrovascular events,60 cases of systemic multiple organ failure(15.00%),and 56 cases of infection(14.00%).The median duration of dialysis in patients with diabetic nephropathy is lower than that in patients with non-diabetic nephropathy[35.25(3.00,153.10)months vs.55.00(3.00,290.00)months,Z=3.237,P=0.032],while the median post-dialysis period in elderly dialysis patients The survival time is lower than that of non-elderly dialysis patients[29.25(3.00,196.03)months vs.100.75(3.00,312.10)months,Z=4.375,P=0.014].COX multivariate analysis showed that male,age≥60 years old,no arteriovenous fistula,and diabetes mellitus were independent risk factors for all-cause mortality in MHD patients[HR(95%CI)=1.333(1.108-1.586),2.144(1.651-2.784),3.125(2.361-3.597),1.234(1.021-1.491)].Conclusion Cardiovascular events,cerebrovascular events,systemic multiple organ failure,and infection are the main causes of death in MHD patients.Male,age≥60 years,no use of arteriovenous fistula,and diabetes are independent risk factors for death in MHD patients.