Dose of hemodialysis and survival - Differences by race and sex
Dose of hemodialysis and survival - Differences by race and sex
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DOI：
10.1001/jama.280.20.1764
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发表时间：
1998-11-25
影响因子：
120.7
通讯作者：
Lowrie, EG
中科院分区：
文献类型：
--
作者：
Owen, WF;Chertow, GM;Lowrie, EG
背景。虽然黑人接受的血液透析剂量低于白人，但他们接受透析治疗时的生存率高于白人。先前关于透析剂量与患者生存率之间关系的研究并未控制患者特征的差异。研究按种族和性别分类的患者群的死亡率与血液透析失败的相关性。使用全国血液透析患者数据库对1994年的实验室数据和死亡率结果进行回顾性分析。共有18144名黑人和白色患者每周接受3次血液透析，这些患者要么在接受血液透析的一年中存活，要么死亡。在控制人种、性别、年龄和糖尿病后，单次透析中的尿素减少分数作为测量的血液透析剂量（尿素减少率[URR]）。死亡率由URR、白蛋白和肌酐水平分层确定。在所有年龄组中，黑人的URR低于白人，男性的URR低于女性。在评估URR、种族、性别和糖尿病之间相互作用的年龄调整模型中，URR与死亡风险的相关性在黑人中很弱，尤其是黑人男性。校正年龄和糖尿病后，URR值小于60%的白色女性的死亡概率曲线最陡。黑人男性的死亡概率曲线最不陡峭。有没有死亡概率和白蛋白或肌酐浓度之间的种族性别聚类有意义的差异。使用URR（血液透析剂量的常用指标），透析剂量与生存率之间的相关性在人口统计学组中一致的假设似乎不正确。透析患者生存质量的比较不应仅依赖URR来预测患者生存。
Context.-Although blacks receive lower doses of hemodialysis than whites, their survival when receiving dialysis treatment is better than that for whites. Previous studies of the relationship between the dose of dialysis and patient survival have not controlled for differences in patient characteristics.Objective.-To examine the association of mortality with the lose of hemodialysis for clusters of patients categorized by race and sex.Design.-Retrospective analysis of laboratory data and mortality outcomes from 1994, using a national database of hemodialysis patients.Patients.-A total of 18144 black and white patients receiving hemodialysis 3 times weekly who either lived the entire year receiving hemodialysis or died.Main Outcome Measures.-The fractional reduction of urea in a single dialysis session as the measured hemodialysis dose (urea reduction ratio [URR]) after controlling for race, sex, age, and diabetes mellitus. Mortality was determined by strata of URRs and albumin and creatinine levels.Results.-Across all age categories, blacks had lower URRs than whites, and men had lower URRs than women. In an age-adjusted model for evaluating interactions among URRs, race, sex, and diabetes, the association of URR with mortality risk was weak among blacks, particularly black men. After adjustment for age and diabetes, death probability curves were most steep for white women with URR values less than 60%. The death probability curves were least steep for black men. There was no meaningful difference between death probability and albumin or creatinine concentration among the race by sex clusters.Conclusion.-Using URR, the usual measure of hemodialysis dose, the assumption that the association between dialysis dose and survival is uniform across demographic groups appears incorrect. Comparisons of the quality of dialysis patient cave should not rely on URR alone to predict patient survival.