透析血流量与维持性血液透析患者全因死亡率关系的研究

Impact of blood flow rate on mortality in hemodialysis patients

目的研究透析血流量(blood flow rate,BFR)对维持性血液透析(maintenance hemodialysis,MHD)患者全因死亡率的影响,寻求最佳血流量。方法从中国国家肾脏数据系统中选择了中国人民解放军陆军特色医学中心肾内科MHD患者进行回顾性研究。根据本研究的BFR中位数,将患者分为BFR≤213.7 mL/min和>213.7 mL/min两组,主要结局是全因死亡率。结果共纳入405例MHD患者。BFR在200~250 mL/min之间的患者为341例(84.2%)。BFR≤213.7 mL/min与BFR>213.7 mL/min全因死亡率之比为49(24.3%)∶26(12.8%)。BFR是MHD患者全因死亡的独立预测因子。BFR在180~250 mL/min范围内,BFR的增加可降低3.6%全因死亡风险(HR=0.974,95%CI:0.957~0.992,P=0.004)。中国人民解放军陆军特色医学中心的最佳血流量cut-off值为211.35 mL/min。在多变量Cox回归分析中,BFR对死亡风险的影响可能在使用高通量透析器、非糖尿病患者和年龄<60岁的患者中更为显著。结论BFR>213.7 mL/min与患者全因死亡率降低独立相关(HR=0.499,95%CI:0.285~0.873,P=0.015)。

Objective To explore the impact of blood flow rate(BFR)on all-cause mortality in chronic hemodialysis(HD)patients.Methods A total of 405 HD patients were selected from CNRDS(Chinese National Renal Data System).According to the median value of BFR,they were assigned into two groups of BFR≤213.7 mL/min and>213.7 mL/min.The primary endpoint was all-cause mortality.Results Among them,341(84.2%)patients had BFR of 200-250 mL/min.The mortality of patients was 49(24.3%)in BFR≤213.7 mL/min and 26(12.8%)in BFR>213.7 mL/min.BFR was an independent risk factor of mortality.Higher BFR was associated with a decline in all-cause mortality risk(HR:0.974,95%CI:0.957-0.992,P=0.004).Optimal cut-off BFR was 211.35 mL/min.According to multivariate Cox regression analyses,the impact of BFR on mortality was more prominent in patients on a high flux dialyzer,nondiabetic and age<60 year.Conclusion Within a range of 180-250 mL/min,higher BFR is independently associated with a lower risk of all-cause mortality in chronic HD patients.