Risk Factors for Dialysis Withdrawal: An Analysis of the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, 1999-2008
Risk Factors for Dialysis Withdrawal: An Analysis of the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, 1999-2008
复制标题
DOI：
10.2215/cjn.07420711
复制
发表时间：
2012-05-01
影响因子：
9.8
通讯作者：
Jose, Matthew D.
中科院分区：
文献类型：
--
作者：
Chan, Hoi Wong;Clayton, Philip A.;Jose, Matthew D.
背景和目的终末期肾病(ESRD)患者的透析停药(DW)越来越重要。这项研究评估了澳大利亚和新西兰DW在透析第一年的死亡原因和危险因素。设计、设置、参与者和测量：这项回顾性观察队列研究包括1999-2008年开始接受肾脏替代治疗的所有澳大利亚和新西兰成年人。结果共纳入24,884名患者，死亡10,073人。死于心脏和社会原因(主要是糖尿病)分别占所有死亡人数的38%和28%。DW的累积发生率1年为3.5%(95%可信区间3.3%~3.8%)，3年9.0%(95%可信区间8.6%~9.4%)，5年13.4%(95%可信区间12.8%~13.9%)。在多变量分析中，第一年DW的预测因素是高龄(每十年1.7[95%可信区间，1.59-1.83]；P<；0.001)，晚期转诊(自发性高血压，1.83[95%可信区间，1.59-2.11]；P<；0.001)，合并症(自发性高血压，每增加一种并存条件，1.33[95%可信区间，1.25-1.41]；0.001)和糖尿病(自发性高血压，1.16[95%可信区间1.00~1.34]；P=0.05)。DW的阴性预测因素包括男性(SHR，0.75[95%CI，0.66-0.87]；P<；0.001)、土著民族(SHR，0.74[95%CI，0.58-0.95]；P<；P=0.02)、其他非白人种族(SHR，0.66[95%CI，0.48-0.91]；P=0.01)、腹膜透析使用者(SHR，0.59[95%CI，0.49-0.72]；P<；0.001)。结论DW在澳大利亚和新西兰的透析患者中很常见。危险因素包括高龄、女性、白人、糖尿病、较高的合并症负担、血液透析使用者以及较晚转诊至肾科医生。临床J am Soc Nephrol 7：775-781,2012。DOI：10.2215/CJN.07420711
Background and objectives Dialysis withdrawal (DW) in patients with ESRD is increasing in importance. This study assessed causes of death and risk factors for DW in Australia and New Zealand in the first year of dialysis.Design, setting, participants, & measurements This retrospective observational cohort study included all adult Australians and New Zealanders beginning renal replacement therapy in 1999-2008.Results A total of 24,884 patients with 10,073 deaths were included. Deaths from cardiac and social causes (predominantly DW) accounted for 38% and 28% of all deaths, respectively. Cumulative incidence of DW was 3.5% at 1 year (95% confidence interval [CI] 3.3%-3.8%), 9.0% at 3 years (95% CI, 8.6%-9.4%), and 13.4% at 5 years (95% CI, 12.8%-13.9%). In multivariate analysis, predictors for DW in the first year were older age (sub-hazard ratio [SKR], 1.70 per decade [95% CI, 1.59-1.83]; P < 0.001), late referral (SHR, 1.83 [95% CI, 1.59-2.11]; P < 0.001), comorbid conditions (SHR, 1.33 per each additional comorbid condition [95% CI, 1.25-1.41]; P < 0.001), and diabetes (SHR, 1.16 [95% CI, 1.00-1.34]; P=0.05). Negative predictors for DW included male sex (SHR, 0.75 [95% CI, 0.66-0.87]; P < 0.001), indigenous ethnicity (SHR, 0.74 [95% CI, 0.58-0.95]; P=0.02), other nonwhite race (SHR, 0.66 [95% CI, 0.48-0.91]; P=0.01), and peritoneal dialysis user (SHR, 0.59 [95% CI, 0.49-0.72]; P < 0.001).Conclusions DW is common among dialysis patients in Australia and New Zealand. Risk factors include older age, female sex, white race, diabetes, higher comorbidity burden, hemodialysis user, and late referral to nephrologist. Clin J Am Soc Nephrol 7: 775-781, 2012. doi: 10.2215/CJN.07420711