Cardiac diseases in maintenance hemodialysis patients: Results of the HEMO Study
Cardiac diseases in maintenance hemodialysis patients: Results of the HEMO Study
复制标题
DOI：
10.1111/j.1523-1755.2004.00657.x
复制
发表时间：
2004-06-01
影响因子：
19.6
通讯作者：
Levey, AS
中科院分区：
文献类型：
--
作者：
Cheung, AK;Sarnak, MJ;Levey, AS
背景心脏病是慢性血液透析患者常见的死亡原因。对血液透析（HEMO）研究中的心脏疾病数据进行了亚分析。具体目标是：（1）分析基线时心脏病的患病率;（2）描述随访期间各种类型心脏事件的发生率;（3）检查随访期间心脏事件与基线心脏病的相关性;（4）检查剂量和通量干预对各种类型心脏事件的影响。HEMO研究是一项在15个临床中心（包括72个透析单位）的1846名慢性血液透析患者中进行的随机多中心试验。计划的最长随访时间为0.9 - 6.6年，平均实际随访时间为2.84年。干预措施是标准剂量与高剂量和低通量与高通量血液透析的2 × 2析因设计。基线时，80%的患者患有心脏病，包括缺血性心脏病（IHD）（39%）、充血性心力衰竭（40%）、心律失常（31%）和其他心脏病（63%）。共有1685例心脏病住院，其中心绞痛和急性心肌梗死占这些住院的42.7%。随访期间心源性死亡343例，占全部死亡的39.4%。61.5%的心源性死亡与IHD有关。基线时的任何心脏疾病均高度预测随访期间的心源性死亡[相对风险（RR）2.57; 95% CI 1.73-3.83]。剂量或通量分配对全因死亡率的主要结局或首次心脏住院或全因死亡率的主要次要心脏复合结局无显著影响。然而，高通量透析与降低心脏死亡率和首次心脏住院或心脏原因死亡的复合结局相关。HEMO研究确定IHD是心脏病住院和心脏病死亡的主要原因。维持性血液透析人群心脏病预防的未来策略应重点关注这一实体。虽然高通量透析不能降低全因死亡率，但它可能改善心脏结局。这一假设需要进一步研究。
Background. Cardiac disease is a common cause of death in chronic hemodialysis patients. A subanalysis of the data on cardiac diseases in the Hemodialysis (HEMO) Study was performed. The specific objectives were: (1) to analyze the prevalence of cardiac disease at baseline; (2) to characterize the incidence of various types of cardiac events during follow-up; (3) to examine the association of cardiac events during follow-up with baseline cardiac diseases; and (4) to examine the effect of dose and flux interventions on various types of cardiac events.Methods. The HEMO Study is a randomized multi-center trial on 1846 chronic hemodialysis patients at 15 clinical centers comprising 72 dialysis units. The scheduled maximum follow-up duration was 0.9 to 6.6 years, with the mean actual follow-up of 2.84 years. The interventions were standard-dose versus high-dose and low-flux versus high-flux hemodialysis in a 2 x 2 factorial design.Results. At baseline, 80% of patients had cardiac diseases, including ischemic heart disease (IHD) (39%), congestive heart failure (40%), arrhythmia (31%), and other heart diseases (63%). There were a total of 1685 cardiac hospitalizations, with angina and acute myocardial infarction accounting for 42.7% of these hospitalizations. There were 343 cardiac deaths during follow-up, accounting for 39.4% of all deaths. IHD was implicated in 61.5% of the cardiac deaths. Any cardiac disease at baseline was highly predictive of cardiac death during follow-up [relative risk (RR) 2.57; 95% CI 1.73-3.83]. There were no significant effects of dose or flux assignments on the primary outcome of all-cause mortality or the main secondary cardiac composite outcome of first cardiac hospitalization or all-cause mortality. Assignment to high-flux dialysis was, however, associated with decreased cardiac mortality and the composite outcome of first cardiac hospitalization or death from cardiac causes.Conclusion. The HEMO Study identified IHD to be a major cause of cardiac hospitalizations and cardiac deaths. Future strategies for the prevention of cardiac diseases in the maintenance hemodialysis population should focus on this entity. Although high-flux dialysis did not reduce all-cause mortality, it might improve cardiac outcomes. This hypothesis needs to be further examined.