THE UREA REDUCTION RATIO AND SERUM-ALBUMIN CONCENTRATION AS PREDICTORS OF MORTALITY IN PATIENTS UNDERGOING HEMODIALYSIS
THE UREA REDUCTION RATIO AND SERUM-ALBUMIN CONCENTRATION AS PREDICTORS OF MORTALITY IN PATIENTS UNDERGOING HEMODIALYSIS
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DOI：
10.1056/nejm199309303291404
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发表时间：
1993-09-30
影响因子：
158.5
通讯作者：
LAZARUS, JM
中科院分区：
文献类型：
--
作者：
OWEN, WF;LEW, NL;LAZARUS, JM
背景在接受血液透析治疗的终末期肾病患者中，透析期间的溶质清除率和营养充足性是死亡率的决定因素。我们确定了血液透析过程中血尿素氮浓度的降低和血清白蛋白浓度的变化（作为营养状况的指标）对大量血液透析患者死亡率的影响。我们回顾性分析了1990年10月1日至1991年3月31日接受治疗的13，473例患者的人口统计学特征、死亡率、血液透析持续时间、血清白蛋白浓度和尿素降低率（定义为单次透析治疗期间血尿素氮浓度降低的百分比）。死亡风险是尿素减少率和血清白蛋白浓度的函数。与尿素减少率为65%至69%的患者相比，尿素减少率低于60%的患者在随访期间的死亡风险更高（比值比，尿素减少率为55%至59%的患者为1.28，尿素减少率低于55%的患者为1.39）。55%的患者尿素减少率低于60%。透析持续时间不能预测死亡率。血清白蛋白浓度是比尿素减少率更强有力的死亡预测因子（21倍），60%的患者血清白蛋白浓度预测死亡风险增加（值低于4.0 g/dl）。血清白蛋白浓度为3.5 - 3.9 g/dl时死亡的比值比为1.48，浓度为3.0 - 3.4 g/dl时为3.13。糖尿病患者血清白蛋白浓度和尿素减少率低于非糖尿病患者。透析期间尿素减少率低与死亡的比值比增加相关。营养不足加剧了这些风险。
Background. Among patients with end-stage renal disease who are treated with hemodialysis, solute clearance during dialysis and nutritional adequacy are determinants of mortality. We determined the effects of reductions in blood urea nitrogen concentrations during dialysis and changes in serum albumin concentrations, as an indicator of nutritional status, on mortality in a large group of patients treated with hemodialysis.Methods. We analyzed retrospectively the demographic characteristics, mortality rate, duration of hemodialysis, serum albumin concentration, and urea reduction ratio (defined as the percent reduction in blood urea nitrogen concentration during a single dialysis treatment) in 13,473 patients treated from October 1, 1990, through March 31, 1991. The risk of death was determined as a function of the urea reduction ratio and serum albumin concentration.Results. As compared with patients with urea reduction ratios of 65 to 69 percent, patients with values below 60 percent had a higher risk of death during follow-up (odds ratio, 1.28 for urea reduction ratios of 55 to 59 percent and 1.39 for ratios below 55 percent). Fifty-five percent of the patients had urea reduction ratios below 60 percent. The duration of dialysis was not predictive of mortality. The serum albumin concentration was a more powerful (21 times greater) predictor of death than the urea reduction ratio, and 60 percent of the patients had serum albumin concentrations predictive of an increased risk of death (values below 4.0 g per deciliter). The odds ratio for death was 1.48 for serum albumin concentrations of 3.5 to 3.9 g per deciliter and 3.13 for concentrations of 3.0 to 3.4 g per deciliter. Diabetic patients had lower serum albumin concentrations and urea reduction ratios than nondiabetic patients.Conclusions. Low urea reduction ratios during dialysis are associated with increased odds ratios for death. These risks are worsened by inadequate nutrition.