Association of residual urine output with mortality, quality of life, and inflammation in incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study.
Association of residual urine output with mortality, quality of life, and inflammation in incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study.
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DOI：
10.1053/j.ajkd.2010.03.020
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发表时间：
2010-08
期刊：
影响因子：
--
通讯作者：
Coresh J
中科院分区：
文献类型：
--
作者：
Shafi T;Jaar BG;Plantinga LC;Fink NE;Sadler JH;Parekh RS;Powe NR;Coresh J
残余肾功能（RKF）与腹膜透析患者生存率的提高有关，但其在血液透析患者中的作用尚不清楚。尿量可以提供RKF的估计值。本研究的目的是确定尿量与血液透析患者死亡率、生活质量（QOL）和炎症的关系。全国代表性前瞻性队列研究，734例血液透析事件参与者在81家诊所接受治疗;入组，1995-1998年，随访至2004年12月。尿量，定义为每天产生至少250 mL（1杯）尿液，通过基线和第1年的问卷调查确定。主要结局为全因死亡率和心血管（CVD）死亡率，采用考克斯回归分析，调整人口统计学、临床和治疗特征。次要结局为QOL、炎症（CRP和白细胞介素-6 [IL-6]水平）和促红细胞生成素（EPO）需求。617/734（84%）参与者在基线时报告了尿量，163/579（28%）在第1年报告了尿量。基线尿量与生存率无关。第1年的尿量，表明保留RKF，与较低的全因死亡率（风险比[HR]，0.70; 95%置信区间[CI]，0.52-0.93; p=0.02）和较低的CVD死亡率趋势（HR，0.69; 95% CI，0.45-1.05; p=0.09）独立相关。基线时有尿量的参与者报告了更好的QOL，CRP（p=0.02）和IL-6（p=0.03）水平较低。重要的是，第1年有尿量的患者EPO剂量比没有尿量的患者低12，000单位/周（p=0.001）。仅在一部分患者（42%）中测量了尿量，但与自我报告一致（p<0.001）。血液透析患者的RKF与更好的生存率和QOL、更低的炎症和显著更少的EPO使用相关。应定期监测血液透析患者的RKF。开发评估和保存RKF的方法很重要，可能会改善透析护理。
Residual kidney function (RKF) is associated with improved survival in peritoneal dialysis patients but its role in hemodialysis patients is less well known. Urine output may provide an estimate of RKF. The aim of our study was to determine the association of urine output with mortality, quality of life (QOL) and inflammation in incident hemodialysis patients. Nationally representative prospective cohort study 734 incident hemodialysis participants treated in 81 clinics; enrollment, 1995-1998, follow-up until December 2004. Urine output, defined as producing at least 250 mL (1 cup) of urine daily, ascertained by questionnaires at baseline and year 1. Primary outcomes were all-cause and cardiovascular (CVD) mortality, analyzed using Cox regression adjusted for demographic, clinical and treatment characteristics. Secondary outcomes were QOL, inflammation (CRP and interleukin-6 [IL-6] levels) and erythropoietin (EPO) requirements. 617/734 (84%) participants reported urine output at baseline and 163/579 (28%) at year 1. Baseline urine output was not associated with survival. Urine output at year 1, indicating preserved RKF, was independently associated with lower all-cause mortality (Hazard Ratio [HR], 0.70; 95% Confidence Interval [CI], 0.52-0.93; p=0.02) and a trend towards lower CVD mortality (HR, 0.69; 95% CI, 0.45-1.05; p=0.09). Participants with urine output at baseline reported better QOL and had lower CRP (p=0.02) and IL-6 (p=0.03) levels. Importantly, EPO dose was 12,000 units/week lower in those with urine output at year 1 compared with those without (p=0.001). Urine volume was measured in only a subset of patients (42%) but was in agreement with self-report (p<0.001). RKF in hemodialysis patients is associated with better survival and QOL, lower inflammation and significantly less EPO use. RKF should be monitored routinely in hemodialysis patients. Development of methods to assess and preserve RKF is important and may improve dialysis care.
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影响因子：
19.6
作者：
Ates, K;Nergizoglu, G;Ertug, AE
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