Seasonal Variations in Mortality, Clinical, and Laboratory Parameters in Hemodialysis Patients: A 5-Year Cohort Study
Seasonal Variations in Mortality, Clinical, and Laboratory Parameters in Hemodialysis Patients: A 5-Year Cohort Study
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DOI：
10.2215/cjn.03880411
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发表时间：
2012-01-01
影响因子：
9.8
通讯作者：
Kotanko, Peter
中科院分区：
文献类型：
--
作者：
Usvyat, Len A.;Carter, Mary;Kotanko, Peter
背景与目的一般人群的死亡率随季节而变化，但尚不清楚这种现象是否也存在于已知背景死亡率较高且强调心血管死因的血液透析患者中。这项研究旨在评估一大批慢性血液透析患者在5年期间死亡率的季节性变化与临床和实验室变量的关系。设计、设置、参与者和测量：这项研究包括来自美国6个不同气候的州的51个肾脏研究所诊所的15056名患者。结果冬季全死因死亡率和心血管疾病死亡率显著高于其他季节(冬季14.2例/百人年，春季13.1例，秋季12.3例，夏季11.9例)。冬季死亡率的增加在年轻患者、白人和男性中更为明显。在气候不同的地区，季节变化相似。中性粒细胞/淋巴细胞比率以及血清钙、钾和血小板值也有季节性变化。在调整了季节性变化的临床参数后，死亡率的差异消失了。结论在大量透析患者中，观察到总体和心血管死亡率存在显著的季节性变化，这在不同气候地区是一致的。其他生理和实验室参数也有季节性差异。结果表明，病死率差异与生理和实验室参数的季节性有关。在设计和解释透析患者的纵向研究时，应考虑季节性变化。Clin J am Soc Nephrol 7：108-115,2012。DOI：10.2215/CJN.03880411
Background and objectives Mortality varies seasonally in the general population, but it is unknown whether this phenomenon is also present in hemodialysis patients with known higher background mortality and emphasis on cardiovascular causes of death. This study aimed to assess seasonal variations in mortality, in relation to clinical and laboratory variables in a large cohort of chronic hemodialysis patients over a 5-year period.Design, setting, participants, & measurements This study included 15,056 patients of 51 Renal Research Institute clinics from six states of varying climates in the United States. Seasonal differences were assessed by chi-squared tests and univariate and multivariate cosinor analyses.Results Mortality, both all-cause and cardiovascular, was significantly higher during winter compared with other seasons (14.2 deaths per 100 patient-years in winter, 13.1 in spring, 12.3 in autumn, and 11.9 in summer). The increase in mortality in winter was more pronounced in younger patients, as well as in whites and in men. Seasonal variations were similar across climatologically different regions. Seasonal variations were also observed in neutrophil/lymphocyte ratio and serum calcium, potassium, and platelet values. Differences in mortality disappeared when adjusted for seasonally variable clinical parameters.Conclusions In a large cohort of dialysis patients, significant seasonal variations in overall and cardiovascular mortality were observed, which were consistent over different climatic regions. Other physiologic and laboratory parameters were also seasonally different. Results showed that mortality differences were related to seasonality of physiologic and laboratory parameters. Seasonal variations should be taken into account when designing and interpreting longitudinal studies in dialysis patients. Clin J Am Soc Nephrol 7: 108-115, 2012. doi: 10.2215/CJN.03880411