终末期肾病血液透析患者残余肾功能丢失预测模型的探索性研究

Exploratory Study of a Nomogram Prediction Model for Residual Renal Function Loss in Hemodialysis Patients with End-Stage Renal Disease

目的 基于终末期肾病(ESRD)血液透析患者残余肾功能(RKF)丢失的危险因素构建列线图预测模型。方法 选取2010年12月至2021年6月宝鸡市中医医院的157例ESRD血液透析患者作为研究对象,收集临床资料。通过LASSO回归和多因素COX回归筛选RKF丢失的危险因素,构建列线图预测模型并进行评价。结果 筛选出RKF丢失的危险因素为性别、糖尿病史、残余尿量、低密度脂蛋白胆固醇、白蛋白、钙、磷;建立预测模型,一致性指数(C-index)为0.676,血液透析开始后24、36个月预测模型受试者工作特征(ROC)曲线下面积(AUC)分别为80.485和95.788;校准曲线和决策曲线显示出模型良好的一致性和临床实用性。结论 本研究建立的ESRD血液透析患者开始治疗24、36个月发生RKF丢失的列线图预测模型,可较准确地预测预后。

Objective To establish a nomogram to predict the risk of residual kidney function(RKF)loss in hemodialysis patients with end-stage renal disease(ESRD).Methods A total of 157 ESRD patients who underwent hemodialysis in Baoji Hospital of Traditional Chinese Medicine from December 2010 to June 2021 were selected as research objects.Clinical data were collected and patients were followed up.The risk factors for RKF loss were screened by LASSO regression and COX multivariate regression.A nomogram prediction model was constructed and evaluated.Results The risk factors for RKF loss finally screened out were gender,history of diabetes,residual urine volume,low-density lipoprotein cholesterol,albumin,calcium and phosphorus.A nomogram prediction model was constructed based on the above factors.The index of concordance(C-index)of the prediction model was 0.676,and the areas under the receiver operating characteristic curves of the 24-month and 36-month prediction models were 80.485 and 95.788,respectively.Calibration curve and decision curve analysis showed good consistency and clinical benefit.Conclusion The nomogram prediction model constructed in this study has good predictive efficacy for the risk of RKF loss in hemodialysis patients at 24 months and 36 months after the initiation of hemodialysis treatment.