维持性血液透析不同透析时机与生存预后的相关性

Correlation between different timing of dialysis and survival prognosis in maintenance hemodialysis

目的:回顾性分析维持性血液透析不同透析时机与生存预后的相关性。方法:回顾性分析2019年10月至2020年10月南京中医药大学江阴附属医院血液净化中心接收的终末期肾病患者170例的临床资料,根据肾小球滤过率(estimated glomerular filtration rate,eGFR)将患者分为A组(88例)和B组(82例),A组eGFR>5 mL/(min·1.73 m^(2)),B组eGFR≤5 mL/(min·1.73 m^(2))。对比2组临床资料、实验室指标、生存时间及临床转归情况,并对维持性血液透析患者透析时机与生存预后的相关性进行Cox多因素分析。结果:2组性别、平均年龄、透析时间、eGFR、原发疾病、糖尿病史、高血压病史、首次血管通路比较,差异均有统计学意义(均P<0.05)。2组血肌酐(serum creatinine,SCr)、尿素氮(urea nitrogen,BUN)、尿酸(uric acid,UA)、血钾、血钙、血磷、血氯、血镁、白蛋白(albumin,ALB)、总胆固醇(total cholesterol,TC)、血红蛋白、红细胞压积水平比较,差异均有统计学意义(均P<0.05)。2组6、12、18、24个月生存率比较,差异均无统计学意义(均P>0.05)。经Cox单因素分析,年龄、透析时间、首次血管通路、糖尿病史、高血压病史、SCr、BUN、ALB对患者生存预后均有显著影响(均P<0.05)。经Cox多因素分析,年龄、透析时间均是生存预后的危险因素(均P<0.05)。结论:患者处于较低eGFR水平时,实施维持性血液透析对于患者的生存预后并无显著影响,此刻进行治疗可缓解家庭及社会负担,同时临床应强化对老年、新入维持性血液透析患者并发症的监测,从而尽可能延长患者透析时间,改善患者生存预后。

Objective:To retrospectively analyze the correlation between different timing of maintenance hemodialysis and survival prognosis.Methods:The clinical data of 170 patients with end-stage renal disease received by the blood purification center of Jiangyin Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from October 2019 to October 2020 were analyzed retrospectively.The patients were divided into group A with 88 patients and group B with 82 patients according to the estimated glomerular filtration rate(eGFR).eGFR was more than 5 mL/(min·1.73 m^(2))in Group A,and eGFR was less than 5 mL/(min·1.73 m^(2))in Group B.The clinical data,laboratory indicators,survival time and clinical outcomes in the 2 groups were compared,and the correlation between dialysis timing and survival prognosis of patients who need maintenance hemodialysis was analyzed by Cox multifactor analysis.Results:There were significant differences between the 2 groups in gender,average age,dialysis time,eGFR,primary disease,history of diabetes,history of hypertension,and first vascular access(all P<0.05).The levels of serum creatinine(SCr),urea nitrogen(BUN),uric acid(UA),blood potassium,blood calcium,blood phosphorus,blood chlorine,blood magnesium,albumin(ALB),total cholesterol(TC),hemoglobin,and hematocrit in the 2 groups had statistically significant difference(all P<0.05).There was no significant difference between the 2 groups in 6-month,12-month,18-month,and 24-month survival rates(all P>0.05).By Cox single factor analysis,age,dialysis time,first vascular access,history of diabetes,history of hypertension,SCr,BUN,ALB had a significant impact on the survival prognosis of patients(all P<0.05).By Cox multivariate analysis,age and dialysis time were the risk factors for survival and prognosis(both P<0.05).Conclusion:Maintenance hemodialysis at a low glomerular filtration rate has no significant impact on survival prognosis.Treatment at this time can ease the burden of family and society.At the same time,clinical monitoring of the complications of elderly and new maintenance hemodialysis patients should be strengthened,so as to prolong the dialysis time of patients as much as possible to improve the survival prognosis of patients.