Skipped treatments, markers of nutritional nonadherence, and survival among incident hemodialysis patients
Skipped treatments, markers of nutritional nonadherence, and survival among incident hemodialysis patients
复制标题
DOI：
10.1053/j.ajkd.2005.09.002
复制
发表时间：
2005-12-01
影响因子：
13.2
通讯作者：
Meyer, KB
中科院分区：
文献类型：
--
作者：
Unruh, ML;Evans, IV;Meyer, KB
背景 跳过血液透析治疗和不遵守规定的饮食被认为会对血液透析患者造成伤害。方法：我们检查了跳过血液透析的预测因素和不依从性的实验室测量，然后检查了跳过透析以及血清钾和磷酸盐水平与生存的关系。结果：在 739 名患者中，67 名患者因缺席超过 3% 的预定治疗而被归类为队长。黑人种族（比值比 [OR]，2.26；95% 置信区间 [CI]，1.30 至 3.92）、当前吸烟（OR，1.79；95% CI，1.02 至 3.13）和使用非法药物（OR，3.96；95% CI，2.16 至 7.24）与跳绳有关。白种人、血清磷酸盐水平升高、肌酐水平升高和体重指数降低增加了血清钾水平超过 5.0 mEq/L (mmol/L) 的可能性；年龄较小、血清钾水平较高和血清肌酐水平较高与血清磷酸盐水平大于 5.5 mg/dL (> 1.78 mmol/L) 相关。跳绳与死亡风险增加相关（风险比 [HR]，1.69；95% Cl，1.24 至 2.31），磷酸盐水平高于 5.5 mg/dL（HR，1.59；95% Cl，1.16 至 2.17）和钾水平高于 5.0 mEq/L（HR，1.50；95% Cl， 1.10 至 2.06）。在 65 岁以下的人群中，跳绳与肾移植的可能性较低相关（OR，0.41；95% Cl，0.18 至 0.93）。结论：这些研究结果表明，黑人血透患者和目前吸烟或使用非法药物的患者有跳过透析治疗的风险。跳过治疗和饮食依从性差的标志与更大的死亡风险密切相关。针对高危患者了解不依从的原因并进行干预可以防止过早死亡。
Background Skipping hemodialysis treatments and failing to adhere to prescribed diets are thought to injure hemodialysis patients. Methods: We examined predictors of hemodialysis skipping and laboratory measures of nonadherence and then examined the association of dialysis skipping and serum potassium and phosphate levels with survival. Results:Of 739 patients, 67 were classified as skippers because they were absent for greater than 3% of scheduled treatments. Black race (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.30 to 3.92), current smoking (OR, 1.79; 95% Cl, 1.02 to 3.13), and use of illicit drugs (OR, 3.96; 95% Cl, 2.16 to 7.24) were associated with skipping. White race, increased serum phosphate level, greater creatinine level, and lower body mass index increased the likelihood of a serum potassium level greater than 5.0 mEq/L (mmol/L); younger age, greater serum potassium level, and greater serum creatinine level were associated with a serum phosphate level greater than 5.5 mg/dL (> 1.78 mmol/L). Skipping was associated with an increased risk for death (hazard ratio [HR], 1.69; 95% Cl, 1.24 to 2.31), as were phosphate level greater than 5.5 mg/dL (HR, 1.59; 95% Cl, 1.16 to 2.17) and potassium level greater than 5.0 mEq/L (HR, 1.50; 95% Cl, 1.10 to 2.06). Skipping was associated with a lower likelihood of kidney transplantation in those younger than 65 years (OR, 0.41; 95% Cl, 0.18 to 0.93). Conclusion: These findings show that hemodialysis patients of black race and those with current tobacco or illicit drug use are at risk for skipping dialysis treatments. Skipping treatments and markers of poor dietary adherence are strongly associated with greater risk for death. Targeting high-risk patients to understand reasons for nonadherence and to intervene could prevent premature death.