Mortality risk for patients receiving hemodiafiltration versus hemodialysis: European results from the DOPPS
Mortality risk for patients receiving hemodiafiltration versus hemodialysis: European results from the DOPPS
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DOI：
10.1038/sj.ki.5000447
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发表时间：
2006-06-01
影响因子：
19.6
通讯作者：
Port, F. K.
中科院分区：
文献类型：
--
作者：
Canaud, B.;Bragg-Gresham, J. L.;Port, F. K.
血液透析滤过（HDF）在欧洲偶尔用于肾脏替代治疗，但在美国未使用。在透析结局和实践模式研究中，比较了5个欧洲国家接受HDF与血液透析（HD）患者的特征和结局。该研究从1998年至2001年随访了2165名患者，分为四组：低通量和高通量HID，以及低效率和高效率HDF。采用多变量逻辑回归分析比较各组患者的特征，包括年龄、性别、14种共病和透析时间。考克斯比例风险回归评估死亡风险的调整差异。HDF的患病率范围为西班牙的1.8%至意大利的20.1%。与低通量HID相比，接受低效率HDF的患者的终末期肾病平均持续时间显著更长（7.0 vs 4.7年），更多癌症史（15.4%对8.7%），低磷（5.3对5.6毫克/分升）;接受高效HDF的患者肺部疾病明显更多（15.5% vs 10.2%），单池Kt/V更高（1.44 vs 1.35）。高效HDF患者的粗死亡率低于低通量HD患者。调整后，高效HDF患者的死亡风险比接受低通量HD的患者显著降低35%（相对风险= 0.65，P = 0.01）。这些观察结果表明，HDF可提高患者生存率，与其较高的透析剂量无关。由于可能存在选择偏倚，因此在推荐临床实践之前，必须通过对照临床试验对HDF的潜在获益进行测试。
Hemodiafiltration (HDF) is used sporadically for renal replacement therapy in Europe but not in the US. Characteristics and outcomes were compared for patients receiving HDF versus hemodialysis (HD) in five European countries in the Dialysis Outcomes and Practice Patterns Study. The study followed 2165 patients from 1998 to 2001, stratified into four groups: low- and high-flux HID, and low- and high-efficiency HDF. Patient characteristics including age, sex, 14 comorbid conditions, and time on dialysis were compared between each group using multivariate logistic regression. Cox proportional hazards regression assessed adjusted differences in mortality risk. Prevalence of HDF ranged from 1.8% in Spain to 20.1% in Italy. Compared to low-flux HID, patients receiving low-efficiency HDF had significantly longer average duration of end-stage renal disease (7.0 versus 4.7 years), more history of cancer (15.4 versus 8.7%), and lower phosphorus (5.3 versus 5.6 mg/dl); patients receiving high-efficiency HDF had significantly more lung disease (15.5 versus 10.2%) and received a higher single-pool Kt/V (1.44 versus 1.35). High-efficiency HDF patients had lower crude mortality rates than low-flux HD patients. After adjustment, high-efficiency HDF patients had a significant 35% lower mortality risk than those receiving low-flux HD (relative risk = 0.65, P = 0.01). These observational results suggest that HDF may improve patient survival independently of its higher dialysis dose. Owing to possible selection bias, the potential benefits of HDF must be tested by controlled clinical trials before recommendations can be made for clinical practice.