Dialyzer membrane permeability and survival in hemodialysis patients
Dialyzer membrane permeability and survival in hemodialysis patients
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DOI：
10.1053/j.ajkd.2004.11.014
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发表时间：
2005-03-01
影响因子：
13.2
通讯作者：
Aparicio, M
中科院分区：
文献类型：
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作者：
Chauveau, P;Nguyen, H;Aparicio, M
背景：我们之前在对1610名血液透析患者进行的30个月的前瞻性随访中表明，营养蛋白浓度可预测预后，而反映身体成分和透析剂量的变量则不能预测预后。透析膜和促红细胞生成素使用的信息必须在额外的随访中进行评估。方法：在2年的延长随访中，从最初的1610例队列中选取650例患者进行生存分析。收集了详细数据：人口统计数据；肾功能衰竭的原因；透析治疗时间；膜的类型；促红细胞生成素治疗;体重指数（BMI）；透析前白蛋白、白蛋白和碳酸氢盐水平；和结果。根据透析前和透析后的尿素和肌酐值计算标准化蛋白质分解代谢率（nPCR）、透析充分性和瘦体重。结果：患者年龄61 +/- 16岁，58%为男性，BMI 22.7 +/- 4.4 kg/m(2)，透析治疗时间102 +/- 73个月，8.8%患有糖尿病。透析时间为247 +/- 31 min， Kt/V为1.4 +/- 0.3，nPCR为1.2 +/- 0.3 g/kg/d。白蛋白水平为3.73 +/- 0.53 g/dL (37.3 +/- 5.3 g/L)，前白蛋白水平为31 +/- 8 mg/dL。2年后生存率为78.7%。生存率受年龄、糖尿病的存在、高通量膜的使用和血清白蛋白水平的影响，但不受其他变量的影响，包括Kt/V和白蛋白前水平。在单变量分析中，尿素、肌酐和体重在两年内的变化可预测患者的生存，而非多变量分析。结论：在长期透析治疗的患者中，使用高通量透析膜可以提高生存率。
Background: We previously showed that nutritional protein concentrations were predictive of outcome, whereas variables reflecting body composition and dialysis dose were not, in a 30-month prospective follow-up of 1,610 hemodialysis patients. Information on dialysis membrane and erythropoietin use had to be evaluated in an additional follow-up. Methods: A subset of 650 patients from the initial cohort of 1,610 was analyzed for survival in a 2-year extension of follow-up. Detailed data were collected: demographics; cause of renal failure; time on dialysis therapy; type of membrane; erythropoietin treatment; body mass index (BMI); predialysis albumin, prealbumin, and bicarbonate levels; and outcome. Normalized protein catabolic rate (nPCR), dialysis adequacy, and lean body mass were computed from predialysis and postdialysis urea and creatinine values. Results: Patient characteristics were age of 61 +/- 16 years, 58% men, BMI of 22.7 +/- 4.4 kg/m(2), time on dialysis therapy of 102 +/- 73 months, and 8.8% had diabetes. Dialysis parameters were duration of 247 +/- 31 minutes, Kt/V of 1.4 +/- 0.3, and nPCR of 1.2 +/- 0.3 g/kg/d. Albumin level was 3.73 +/- 0.53 g/dL (37.3 +/- 5.3 g/L), and prealbumin level was 31 +/- 8 mg/dL. The survival rate was 78.7% after 2 years. Survival was influenced by age, presence of diabetes, use of high-flux membrane, and serum albumin level, but not other variables, including Kt/V and prealbumin level. Two-year variations in values for urea, creatinine, and weight were predictive of survival in univariate, but not multivariate, analyses. Conclusion: In patients on dialysis therapy for a long period, better survival was observed when high-flux dialysis membranes were used.