衰弱对老年血液透析患者预后的影响

Effect of frailty on prognosis in elderly hemodialysis patients:a prospective cohort study

目的探讨衰弱对行维持性血液透析的慢性肾脏病患者的预后影响。方法选取2018年1月至2020年6月于南京中医药大学南通附属医院血液净化中心实施维持性血液透析的140例患者的临床资料。按照患者是否发生衰弱分为无衰弱组(无衰弱或衰弱前期,93例)和衰弱组(47例)。对患者进行为期12个月的随访,记录患者的死亡时间、发生原因、不良事件发生情况。结果无衰弱组患者的12个月生存率明显高于衰弱组,差异有统计学意义(P=0.008)。衰弱组患者的12个月全因死亡率、急诊就医率、住院治疗率均高于无衰弱组,差异均有统计学意义(均P<0.05)。两组患者的12个月不良事件发生率(跌倒发生率、急性心血管)比较,差异无统计学意义(P>0.05)。Cox风险比例模型分析结果显示衰弱是导致全因死亡率增加的危险因素(HR=4.121,95%CI:1.113~12.44,P=0.036)。回归分析结果显示衰弱是导致患者急诊就医率增加的危险因素(IRR=2.750,95%CI:1.643~4.532,P<0.001);衰弱并非跌倒、住院治疗、急性心血管不良事件发生的危险因素(均P>0.05)。结论衰弱是导致行维持性血液透析的慢性肾脏病患者全因死亡率和急诊就医率增加的危险因素。

Objective To investigate the effect of frailty on the prognosis of chronic kidney disease patients undergoing maintenance hemodialysis.Methods A prospective cohort study was conducted on the clinical data of 140 patients who underwent maintenance hemodialysis at the Blood Purification Center of Nantong Affiliated Hospital of Nanjing University of Chinese Medicine from January 2018 to June 2020.According to whether the patients had frailty,they were divided into non-frailty group(no frailty or pre-frailty,93 cases)and frailty group(47 cases).The patients were followed up for 12 months,and the time of death,cause of occurrence and occurrence of adverse events were recorded.Results The 12-month survival rate in the non-frailty group was significantly higher than that in the frailty group,and the difference was statistically significant(P=0.008).The 12-month all-cause mortality,emergency medical treatment rate and hospitalization rate of patients in the frailty group were higher than those in the non-frailty group,and the differences were statistically significant(all P<0.05).There was no significant difference in the 12-month incidence of adverse events(incidence of falls and acute cardiovascular disease)between the two groups(P>0.05).Cox hazard proportional model analysis showed frailtness was a risk factor for increased all-cause mortality(HR=4.121,95%CI:1.113~12.44,P=0.036).Regression analysis showed that faltering was a risk factor for increasing the rate of emergency visits(IRR=2.750,95%CI:1.643~4.532,P<0.001).Frailty was not a risk factor for falls,hospitalization or acute cardiovascular adverse events(all P>0.05).Conclusions Frailty is a risk factor for increased all-cause mortality and emergency visit in patients with chronic kidney disease undergoing maintenance hemodialysis.