Predictive value of functional status for mortality in patients on maintenance hemodialysis
Predictive value of functional status for mortality in patients on maintenance hemodialysis
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DOI：
10.1159/000013318
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发表时间：
1998-03-01
影响因子：
4.2
通讯作者：
Friedman, EA
中科院分区：
文献类型：
--
作者：
Ifudu, O;Paul, HR;Friedman, EA
在接受维持性血液透析的患者中，实验室指标（如血清白蛋白浓度）主要用于评估健康状况，而功能状态的测量很少应用。然而，血清白蛋白浓度随着年龄的增长而下降，现在开始维持性血液透析的患者的平均年龄超过63岁。使用14级改良Karnofsky活动量表，我们测量了522例随机选择的血液透析患者的基线功能状态，并前瞻性监测了3年，以确定我们的改良Karnofsky评分对死亡率的预测价值。在研究开始时，测量血清白蛋白和肌酐浓度以及红细胞压积，并记录共病状况。基线时，522例受试者（270例女性和252例男性）包括327例黑人（63%）、154例白人（29%）、31例西班牙裔（6%）和10例亚洲人（2%），平均年龄59 ±（SD）15岁。终末期肾病的平均病程为4 +/- 3.6年，平均血清白蛋白浓度为3.7 +/- 0.4 g/dl。166例（32%）患者在观察期间死亡。考克斯回归分析显示死亡率与我们的改良Karnofsky评分（p = 0.0001）和血清白蛋白浓度（p = 0.001）呈负相关。在对根据血清白蛋白浓度分层的受试者进行分析后，低改良Karnofsky评分对死亡率的预测价值仍然存在（
In patients receiving maintenance hemodialysis, laboratory indices (such as serum albumin concentration) are predominantly utilized to assess well-being, while measures of functional status are rarely applied. However, the serum albumin concentration declines with advancing age, and the mean age of patients starting maintenance hemodialysis is now over 63 years. Using a 14-level modified Karnofsky activity scale, we measured baseline functional status in 522 randomly selected hemodialysis patients and prospectively monitored them for 3 years to determine the predictive value of our modified Karnofsky score for mortality. At onset of study, serum albumin and creatinine concentrations as well as hematocrit were measured and the comorbid conditions documented. At baseline, the 522 subjects (270 women and 252 men) included 327 blacks (63%), 154 whites (29%), 31 Hispanics(6%), and 10 Asians (2%) of mean age 59 +/- (SD) 15 years. The mean duration of end-stage renal disease was 4 +/- 3.6 years, and the mean serum albumin concentration was 3.7 +/- 0.4 g/dl. 166 (32%) of the patients died during the observation period. Cox regression analysis revealed inverse relations between mortality and both our modified Karnofsky score (p = 0.0001) and serum albumin concentration (p = 0.001). The predictive value of a low modified Karnofsky score for mortality persisted after analysis of subjects stratified according to serum albumin concentration (