Dialyzer Classification and Mortality in Hemodialysis Patients: A 3-Year Nationwide Cohort Study.
Dialyzer Classification and Mortality in Hemodialysis Patients: A 3-Year Nationwide Cohort Study.
复制标题
DOI：
10.3389/fmed.2021.740461
复制
发表时间：
2021
影响因子：
3.9
通讯作者：
Nakamoto H
中科院分区：
文献类型：
--
作者：
Abe M;Masakane I;Wada A;Nakai S;Nitta K;Nakamoto H
背景：国际上将透析器分为低通量、高通量和漏蛋白膜透析器，日本根据β2-微球蛋白清除率将透析器分为I、II、III、IV和V型。I型为低通量膜透析器，II型和III型为高通量膜透析器，IV型和V型为漏蛋白膜透析器。在这里，我们的目的是澄清透析类型与死亡率的关系。方法：这项全国性的回顾性队列研究分析了2010年至2013年日本透析治疗学会肾脏数据登记处的数据。我们纳入了238,321例血液透析患者，他们在国际分类中分为低通量组、高通量组和蛋白泄漏组，在日本分类中分为I - V型组。我们使用Cox比例风险模型评估各组与3年全因死亡率的关联，并进行倾向评分匹配分析。结果：截至2013年底，流行透析患者死亡55308例（23.2%）。在国际分类亚组分析中，校正所有混杂因素后，低通量组的风险比（95%可信区间）显著高于高通量组[1.12 (1.03-1.22),P = 0.009]，而蛋白泄漏组的风险比（95%可信区间）显著低于高通量组[0.95 (0.92-0.98),P = 0.006]。在日本分类亚组分析中，校正所有混杂因素后，I型和II型的风险比显著高于IV型[1.10 (1.02-1.19),P = 0.015]和1.10 (1.02-1.39),P = 0.014]，而V型的风险比显著低于IV型[0.91 (0.88-0.94),P < 0.0001]。在两种分类的倾向评分匹配后，这些显著的发现仍然存在。结论：使用漏蛋白透析器进行血液透析可降低死亡率。此外，在血液透析患者中，V型透析器优于IV型透析器。
Background: Dialyzers are classified as low-flux, high-flux, and protein-leaking membrane dialyzers internationally and as types I, II, III, IV, and V based on β2-microglobulin clearance rate in Japan. Type I dialyzers correspond to low-flux membrane dialyzers, types II and III to high-flux membrane dialyzers, and types IV and V to protein-leaking membrane dialyzers. Here we aimed to clarify the association of dialyzer type with mortality. Methods: This nationwide retrospective cohort study analyzed data from the Japanese Society for Dialysis Therapy Renal Data Registry from 2010 to 2013. We enrolled 238,321 patients on hemodialysis who were divided into low-flux, high-flux, and protein-leaking groups in the international classification and into type I to V groups in the Japanese classification. We assessed the associations of each group with 3-year all-cause mortality using Cox proportional hazards models and performed propensity score matching analysis. Results: By the end of 2013, 55,308 prevalent dialysis patients (23.2%) had died. In the international classification subgroup analysis, the hazard ratio (95% confidence interval) was significantly higher in the low-flux group [1.12 (1.03–1.22), P = 0.009] and significantly lower in the protein-leaking group [0.95 (0.92–0.98), P = 0.006] compared with the high-flux group after adjustment for all confounders. In the Japanese classification subgroup analysis, the hazard ratios were significantly higher for types I [1.10 (1.02–1.19), P = 0.015] and II [1.10 (1.02–1.39), P = 0.014] but significantly lower for type V [0.91 (0.88–0.94), P < 0.0001] compared with type IV after adjustment for all confounders. These significant findings persisted after propensity score matching under both classifications. Conclusions: Hemodialysis using protein-leaking dialyzers might reduce mortality rates. Furthermore, type V dialyzers are superior to type IV dialyzers in hemodialysis patients.
登录
查看更多内容
影响因子：
13.2
作者：
ACCHIARDO, S;KRAUS, AP;JENNINGS, BR
通讯作者：
JENNINGS, BR
影响因子：
6.1
作者：
Belmouaz, Mohamed;Bauwens, Marc;Bridoux, Frank
通讯作者：
Bridoux, Frank
影响因子：
1.9
作者：
Masakane, Ikuto;Nakai, Shigeru;Nitta, Kosaku
通讯作者：
Nitta, Kosaku
影响因子：
3.7
作者：
Abe M;Hamano T;Wada A;Nakai S;Masakane I;Renal Data Registry Committee, Japanese Society for Dialysis Therapy
通讯作者：
Renal Data Registry Committee, Japanese Society for Dialysis Therapy
影响因子：
13.6
作者：
Cheung, Alfred K.;Rocco, Michael V.;Eknoyan, Garabed
通讯作者：
Eknoyan, Garabed