Frailty, Dialysis Initiation, and Mortality in End-Stage Renal Disease
Frailty, Dialysis Initiation, and Mortality in End-Stage Renal Disease
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DOI：
10.1001/archinternmed.2012.3020
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发表时间：
2012-07-23
影响因子：
--
通讯作者：
Johansen, Kirsten L.
中科院分区：
文献类型：
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作者：
Bao, Yeran;Dalrymple, Lorien;Johansen, Kirsten L.
背景资料：鉴于最近的趋势是早期透析开始及其与终末期肾病患者死亡率的相关性，我们假设虚弱与透析开始时较高的估计肾小球滤过率（eGFR）相关，并可能混淆早期透析开始与死亡率之间的关系。方法：我们检查了综合透析研究（CDS）参与者的虚弱，CDS是美国肾脏数据系统的一项特殊研究，该研究招募了2005年9月1日至2005年6月1日期间的事件患者，2007.随访患者的生命状态至2009年9月30日，随访至首次住院时间至2008年12月31日。我们使用多变量logistic回归模型的关联性脆弱与eGFR在透析开始和比例风险回归，以评估死亡或住院治疗的结局。结果：在1576 CDS参与者包括，患病率为73%。在多变量分析中，透析开始时较高的eGFR与较高的虚弱几率相关（比值比[OR]，1.44 [95%CI，1.23-1.68]/5 mL/min/1.73 m2; P
Background: In light of the recent trend toward earlier dialysis initiation and its association with mortality among patients with end-stage renal disease, we hypothesized that frailty is associated with higher estimated glomerular filtration rate (eGFR) at dialysis start and may confound the relation between earlier dialysis initiation and mortality.Methods: We examined frailty among participants of the Comprehensive Dialysis Study (CDS), a special study of the US Renal Data System, which enrolled incident patients from September 1, 2005, through June 1, 2007. Patients were followed for vital status through September 30, 2009, and for time to first hospitalization through December 31, 2008. We used multivariate logistic regression to model the association of frailty with eGFR at dialysis start and proportional hazards regression to assess the outcomes of death or hospitalization.Results: Among 1576 CDS participants included, the prevalence of frailty was 73%. In multivariate analysis, higher eGFR at dialysis initiation was associated with higher odds of frailty (odds ratio [OR], 1.44 [95% CI, 1.23-1.68] per 5 mL/min/1.73 m(2); P