Peripheral arterial disease in patients with end-stage renal disease - Observations from the Dialysis Outcomes and Practice Patterns Study (DOPPS)
Peripheral arterial disease in patients with end-stage renal disease - Observations from the Dialysis Outcomes and Practice Patterns Study (DOPPS)
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DOI：
10.1161/circulationaha.105.607390
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发表时间：
2006-10-31
期刊：
影响因子：
37.8
通讯作者：
Saran, Rajiv
中科院分区：
文献类型：
--
作者：
Rajagopalan, Sanjay;Dellegrottaglie, Santo;Saran, Rajiv
终末期肾病患者心血管疾病发病率和死亡率高。本研究的目的是描述外周动脉疾病（PAD）的患病率及其对国际血液透析患者队列的预后和健康相关生活质量（HRQOL）的影响。方法和结果-数据来自透析结局和实践模式研究（DOPPS），一项前瞻性、国际性、观察性的血液透析患者研究。（n = 29 873）。通过逻辑回归分析评估基线临床变量与PAD之间的关联。考克斯回归模型用于检验PAD与全因死亡率、心源性死亡率和住院风险之间的相关性。7411例患者（25.3%）被诊断为PAD，具有显著的地理差异。传统的心血管危险因素包括年龄、男性、糖尿病、高血压和吸烟，以及血液透析的持续时间被确定为PAD的显著相关因素。PAD的诊断与全因死亡率增加相关（风险比[ HR] = 1.36; P < 0.0001），心源性死亡率（HR = 1.43; P < 0.0001），全因住院（HR = 1.19; P < 0.0001）和因主要不良心血管事件住院（HR = 2.05; P < 0.0001）。HRQOL问卷调查显示PAD患者的身体健康评分显著低于非PAD患者（P < 0.0001）。结论：PAD在血液透析患者中很常见，与心血管死亡率、发病率和住院风险增加以及HRQOL降低相关。
Background - Patients with end-stage renal disease are at high risk for cardiovascular morbidity and mortality. The aims of the present study were to describe the prevalence of peripheral arterial disease ( PAD) and its effects on prognosis and health-related quality of life ( HRQOL) in an international cohort of patients on hemodialysis.Methods and Results - Data from the Dialysis Outcomes and Practice Patterns Study ( DOPPS), a prospective, international, observational study of hemodialysis patients ( n = 29 873), were analyzed. Associations between baseline clinical variables and PAD were evaluated by logistic regression analysis. Cox regression models were used to test the association between PAD and risk for all-cause mortality, cardiac mortality, and hospitalization. PAD was diagnosed in 7411 patients ( 25.3%) with significant geographic variation. Traditional cardiovascular risk factors including age, male sex, diabetes, hypertension, and smoking were identified, together with the duration of hemodialysis, as significant correlates of PAD. Diagnosis of PAD was associated with increased all-cause mortality ( hazard ratio [ HR] = 1.36; P < 0.0001), cardiac mortality ( HR = 1.43; P < 0.0001), all-cause hospitalization ( HR = 1.19; P < 0.0001), and hospitalization for a major adverse cardiovascular event ( HR = 2.05; P < 0.0001). HRQOL questionnaires revealed physical health scores that were significantly lower in PAD compared with non-PAD patients ( P < 0.0001).Conclusions - PAD is common in hemodialysis patients and is associated with increased risk of cardiovascular mortality, morbidity, and hospitalization and reduced HRQOL.