Early mortality risk in incident Chinese hemodialysis patients: a retrospective cohort study.
Early mortality risk in incident Chinese hemodialysis patients: a retrospective cohort study.
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DOI：
10.1080/0886022x.2017.1337583
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发表时间：
2017-11
期刊：
影响因子：
3
通讯作者：
Zuo L
中科院分区：
文献类型：
--
作者：
Zhao X;Wang M;Zuo L
背景：维持性血液透析（MHD）患者的早期死亡风险因国家和种族而异。这里对中国 HD 患者的早期死亡率进行了研究。方法：从北京市透析登记系统中提取2007年1月1日至2013年12月31日的数据。所有纳入的患者均随访至2013年底。该透析时间段分为六个间隔（≤120、121-365天；1-2、2-3、3-4、≥5年）。从登记数据库中提取患者的人口统计数据、终末期肾病 (ESRD) 的主要原因、首次 HD 日期、死亡日期、死亡原因、审查日期和原因。按性别、年龄和 ESRD 原因分层计算每个时期的全因死亡率（每 100 名患者年）。还计算了每月死亡率。结果：共纳入11955例患者，其中男性6738例，女性5217例。开始透析时的平均年龄为 57.7±16.1 岁。中位随访时间为 19.8 个月。共有2555人死亡。总体死亡率为每 100 名患者年 8.2 人。每个时期的死亡率分别为18.7、7.5、6.9、6.9、6.5和6.2。前 2 个月的死亡率分别为每 100 名患者年 41.9 人和 16.6 人。老年、女性、糖尿病和高血压患者的死亡率较高。结论：最关键的时期是透析开始的前 2 个月。老年、女性、糖尿病和高血压患者早期死亡的风险较高。我们的分析强调，从严重 CKD 阶段到开始透析的过渡期（此时应采取最佳支持治疗）对于患者的生存至关重要。
Background: Early mortality risk of maintenance hemodialysis (MHD) patients varies by country and ethnicity. Here, early mortality in incident Chinese HD patients were studied. Methods: Data from 1 January 2007 to 31 December 2013 were pulled from Beijing dialysis registry system. All included patients were followed to the end of 2013. This time period of dialysis was divided into six intervals (≤120, 121–365 days; 1–2, 2–3, 3–4, ≥5 years). Patients’ demographics, primary cause of end-stage renal disease (ESRD), date of first HD, date of death, cause for death, date and cause of censoring were extracted from the registry database. All-cause mortality (per 100 patient-years) was calculated for each period stratified by sex, age and cause of ESRD. Monthly mortality rates were also calculated. Results: A total of 11,955 patients were included, 6738 were males and 5217 were females. The mean age at dialysis initiation was 57.7 ± 16.1 years. The median follow-up time was 19.8 months. There were total 2555 deaths. The overall mortality rate was 8.2 per 100 patient-years. Mortality rates were 18.7, 7.5, 6.9, 6.9, 6.5 and 6.2 in each period. The first 2 months mortality rates were 41.9 and 16.6 per 100 patient-years. Higher mortality was observed in patients who were older, female, diabetic and hypertensive. Conclusions: The most critical period was the first 2 months of dialysis initiation. Patients who were older, female, diabetic and hypertensive had higher risk of early mortality. Our analysis highlighted that the transitional period from sever CKD stages to dialysis initiation, when optimal supportive care should be adopted, was crucial for patients’ survival.