What are the Risk Factors for One-Year Mortality in Older Patients with Chronic Kidney Disease? An Analysis of the Cleveland Clinic CKD Registry-猫眼课题宝

DOI：

10.1159/000494298

发表时间：

2019-01-01

期刊：

NEPHRON

影响因子：

2.5

通讯作者：

中科院分区：

医学4区

文献类型：

作者：

Saeed, Fahad;Arrigain, Susana;Navaneethan, Sankar Dass

背景：老年慢性肾脏病(CKD)患者开始透析后的预后因素尚未得到很好的研究。在这项研究中，我们研究了老年CKD患者透析开始后1年死亡率的相关危险因素。方法：在这项回顾性研究中，我们纳入了621名CKD患者，这些患者来自一个基于电子病历的CKD注册中心，该注册中心与美国肾脏数据系统数据相关联。就年龄而言，他们都是65岁。结果：在我们的研究队列中，224名老年患者在透析开始的第一年期间死亡，估计一年存活率为65%(95%可信区间62-69)，在调整协变量后，年龄逐年增加(危险比1.04[95%可信区间1.02-1.061])，充血性心力衰竭(充血性心力衰竭；1.57[1.13-2.18])、无动静脉瘘(3.0[1，7-5.1])和透析开始前缺乏肾脏内科护理(1.93[1.39-2.70])与1年死亡率增加相关。近60%的死亡是由于包括癌症在内的非心血管(CV)原因。结论：高龄CKD患者1年死亡率高的危险因素是年龄增加、充血性心力衰竭、无动静脉瘘和缺乏透析前肾病治疗。临床医生需要意识到这些患者高死亡率的非心血管风险。(C)2018年S卡格尔股份公司，巴塞尔

Background: Prognostic factors after dialysis initiation among older chronic kidney disease (CKD) patients are not well studied. In this study, we examined the risk factors associated with 1-year mortality after dialysis initiation among older CKD patients. Methods: In this retrospective study, we included 621 CKD patients from an electronic medical record based CKD registry that was linked to the United States Renal Data System data. In terms of age, they were all >= 65. We examined the associations of various demographic factors, co-morbid conditions, relevant laboratory parameters, the presence of arteriovenous fistula, and inability to take care of oneself with 1-year mortality after dialysis initiation using Cox proportional hazards model, Results: In our study cohort, 224 older patients died during the first year of dialysis initiation and the estimated survival at 1 year was 65% (95% CI 62-69), After adjusting for covariates, increasing age byeach year (Hazard ratio 1.04 [95% CI 1.02-1.061), congestive heart failure (CHF; 1.57 [1.13-2.18]), an absence of AVF (3.0 [1,7-5.1]) and lack of nephrology care prior to dialysis initiation (1.93 [1.39-2.70]) were associated with increased risk of 1-year mortality. Nearly 60% of deaths were due to non-cardiovascular (CV) causes including cancer. Conclusion: Risk factors portending high 1-year mortality in older CKD patients are increasing age, CHF, an absence of AVF, and lack of pre-dialysis nephrology care. Clinicians need to be aware of non-CV risks of high mortality in these patients. (C) 2018 S Karger AG, Basel

What are the Risk Factors for One-Year Mortality in Older Patients with Chronic Kidney Disease? An Analysis of the Cleveland Clinic CKD Registry

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