Early, intermediate, and long-term risk factors for mortality in incident dialysis patients: The choices for healthy outcomes in caring for ESRD (CHOICE) study
Early, intermediate, and long-term risk factors for mortality in incident dialysis patients: The choices for healthy outcomes in caring for ESRD (CHOICE) study
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DOI：
10.1053/j.ajkd.2007.03.017
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发表时间：
2007-06-01
影响因子：
13.2
通讯作者：
Powe, Neil R.
中科院分区：
文献类型：
--
作者：
Plantinga, Laura C.;Fink, Nancy E.;Powe, Neil R.
背景：了解存活时间较长的透析患者的死亡风险因素是否不同，以及这些死亡风险因素随时间变化的强度将有助于医生做出更好的预后判断。研究设计：前瞻性队列研究。设置和参与者：81 个诊所治疗的 1,041 名透析患者（平均随访时间为 3.1 年）。预测因素：一组简约的风险因素（年龄较大、白种人、失业状况、从几个可用的人口统计、临床和实验室变量中选择（合并症、吸烟、收缩压降低和血清白蛋白水平降低）。结果和测量：每年随访间隔的长期（4年以上）生存和死亡率，通过逻辑回归和Cox比例风险分析进行检查。结果：所有基线风险因素都与4年以上生存机会降低相关，即使在对混杂因素进行调整后也是如此。年龄增长是所有年度间隔内死亡率的一个重要且独立的危险因素；合并症、吸烟和血压降低是早期危险因素；白蛋白水平低和失业状态是中等危险因素；白人种族是一个晚期风险因素。当危险因素随着时间的推移而更新时，低白蛋白水平和严重的合并症在大多数时间间隔内成为显着的危险因素。局限性：缺乏一些随访数据，无法排除残留的混杂因素或根据结果做出因果推断。结论：接受透析治疗的长期幸存者可能与终末期肾病早期患者相比具有不同的死亡危险因素（例如，种族与血压）；其他危险因素可能随着时间的推移保持不变（例如年龄、合并症和白蛋白水平）。这些信息可能有助于指导医生对具有特定透析年份的个体患者做出预后判断。
Background: Knowing whether risk factors for mortality differ in dialysis patients who survive longer and the strengths of these risk factors for mortality change over time would assist physicians in making better prognostic judgments.Study Design: Prospective cohort study.Setting & Participants: 1,041 incident dialysis patients treated in 81 clinics (mean follow-up, 3.1 years).Predictor: A parsimonious set of risk factors (older age, white race, unemployed status, comorbidity, ever smoking, decreased systolic blood pressure, and decreased serum albumin level) chosen from several available demographic, clinical, and laboratory variables.Outcomes & Measurements: Long-term (4+ years) survival and mortality over yearly intervals of follow-up, examined in logistic regression and Cox proportional hazards analyses.Results: All baseline risk factors were associated with a decreased chance of surviving 4+ years, even after adjustment for confounders. Increased age was a strong and independent risk factor for mortality over all yearly intervals; comorbidity, smoking, and decreased blood pressure were early risk factors; low albumin level and unemployed status were intermediate risk factors; and white race was a late risk factor. When risk factors were updated with time, low albumin level and severe comorbidity became significant risk factors over most intervals.Limitations: Lack of some follow-up data and inability to rule out residual confounding or make causal inference based on results.Conclusion: Long-term survivors on dialysis therapy may have different risk factors for mortality than patients in earlier phases of end-stage renal disease (eg, race versus blood pressure); other risk factors may be constant over time (eg, age, comorbidity, and albumin level). Such information may help guide physicians in making prognostic judgments for individual patients with particular dialysis vintages.