Chronic inflammation and mortality in haemodialysis: effect of different renal replacement therapies. Results from the RISCAVID study
Chronic inflammation and mortality in haemodialysis: effect of different renal replacement therapies. Results from the RISCAVID study
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DOI：
10.1093/ndt/gfm951
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发表时间：
2008-07-01
影响因子：
6.1
通讯作者：
Palla, Roberto
中科院分区：
文献类型：
--
作者：
Panichi, Vincenzo;Rizza, Giovanni M.;Palla, Roberto
背景资料。‘rischio CArdiovascolare nei Pazienti afferenti all’Area Vasta in Dialisi‘(RISCAVID)研究是一项观察性和前瞻性试验，包括托斯卡纳西北部的整个慢性血液透析(HD)人群(123.5万人)。本研究的目的是阐明传统和非传统危险因素对血液透析患者死亡率和发病率的相关性，以及不同血液透析模式的影响。共对757例HD患者(平均年龄66+/-14岁，平均透析年龄70+/-76个月，糖尿病19%)进行了30个月的前瞻性随访，记录了全因死亡率、心血管(CV)死亡率和非致命性心血管事件(急性心肌梗死和中风)。在登记时，所有人口的人口、临床和实验室数据都输入了一个中央数据库。在研究开始时集中测定血清白蛋白、高敏C反应蛋白(CRP)、白介素6(IL-6)和白介素8(IL-8)。根据血液透析模式将患者分为三组：标准碳酸氢盐血液透析(BHD)组(n=424)、无菌袋血液透析滤过(HDF)组(n=204)和在线血液透析滤过组(n=129)。COX比例风险回归评估了调整后的心血管发病率和死亡风险的差异；还进行了多因素分析。全因死亡率为12.9%/年，变异系数为5.9%/年。C反应蛋白和促炎细胞因子水平高的患者发生心血管疾病(RR1.9，P<；0.001)和全因死亡率(RR2.57，P<；0.001)的风险增加。经合并症和人口统计学调整后的多变量分析显示，C反应蛋白是最有效的死亡率预测因子(P<；0.001)，其次是IL-6。COX比例风险回归分析显示，在线HDF和HDF患者的调整累积生存率显著高于BHD患者(P<；0.01)。这项研究30个月的数据显示，CRP和促炎细胞因子的协同作用是全因和心血管死亡率的强烈预测因子。HDF与累积存活率的改善有关，与透析剂量无关。
Background. The 'RISchio CArdiovascolare nei pazienti afferenti all' Area Vasta In Dialisi' (RISCAVID) study is an observational and prospective trial including the whole chronic haemodialysis (HD) population in the northwest part of Tuscany (1.235 million people). The aim of the study was to elucidate the relevance of traditional and non-traditional risk factors of mortality and morbidity in HD patients as well as the impact of different HD modalities.Methods. A total of 757 HD patients (mean age 66 +/- 14 years, mean dialytic age 70 +/- 76 months, diabetes 19%) were prospectively followed up for 30 months and all-cause mortality, cardiovascular (CV) mortality and non-fatal CV events (acute myocardial infarction and stroke) were registered. At the time of the enrolment, demographic, clinical and laboratory data of the whole population were entered into a centralized database. Serum albumin, high-sensitive C-reactive protein (CRP), interleukin-6 (IL-6) and interleukin-8 (IL-8) were centrally determined at the start of the study. Patients were stratified into three groups according to the HD modality: standard bicarbonate HD (BHD) (n = 424), haemodiafiltration (HDF) with sterile bags (n = 204) and online HDF (n = 129). The Cox proportional hazards regression assessed adjusted differences in CV morbidity and mortality risk; a multivariate analysis was also performed.Results. All-cause and CV mortality was 12.9%/year and 5.9%/year, respectively. Patients with combined high levels of CRP and pro-inflammatory cytokines showed an increased risk for CV (RR 1.9, P < 0.001) and all-cause mortality (RR 2.57, P < 0.001). Multivariate analysis adjusted for comorbidity and demographic showed CRP as the most powerful mortality predictor (P < 0.001) followed by IL-6. The Cox proportional hazards regression assessed that online HDF and HDF patients had a significantly increased adjusted cumulative survival than BHD (P < 0.01).Conclusions. Data at 30 months from this study showed the synergic effect of CRP and pro-inflammatory cytokines as the strong predictors of all-cause and CV mortality. HDF was associated with an improved cumulative survival independent of the dialysis dose.