Impact of residual kidney function on hemodialysis adequacy and patient survival
Impact of residual kidney function on hemodialysis adequacy and patient survival
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残余肾功能对血液透析充分性和患者生存的影响
DOI：
10.1093/ndt/gfy060
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发表时间：
2018-10-01
影响因子：
6.1
通讯作者：
Kalantar-Zadeh, Kamyar
中科院分区：
文献类型：
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作者：
Wang, Mengjing;Obi, Yoshitsugu;Kalantar-Zadeh, Kamyar
背景。透析剂量和残余肾功能（RKF）都有助于溶质清除，并与血液透析患者的预后相关。我们假设透析剂量和死亡率之间的关联随着rkf的增大而减弱。在美国一家大型透析机构（2007- 2011）的32251例血液透析患者中，我们使用多变量Cox比例风险回归模型，研究了单池Kt/V （spKt/V）和肾尿素清除率（rCL（尿素））水平在生存分析中的相互作用。中位rCL（尿素）和平均基线spKt/V分别为3.06[四分位间距（IQR） 1.74-4.85] mL/min/1.73 m(2)和1.32 +/- 0.28。在中位随访1.2年（EQR为0.5-2.2年）期间，共有7444例（23%）患者死亡，每100例患者年的死亡率为15.4例。校正病例组合和实验室变量的Cox模型显示，rCL（尿素）修正了spKt/V与死亡率之间的相关性（p交互作用= 0.03）；较低的spKt/V与低rCL尿素患者的较高死亡率相关。
Background. Both dialysis dose and residual kidney function (RKF) contribute to solute clearance and are associated with outcomes in hemodialysis patients. We hypothesized that the association between dialysis dose and mortality is attenuated with greater RKF.Methods. Among 32 251 incident hemodialysis patients in a large US dialysis organization (2007-11), we examined the interaction between single-pool Kt/V (spKt/V) and renal urea clearance (rCL(urea)) levels in survival analyses using multivariable Cox proportional hazards regression model.Results. The median rCL(urea) and mean baseline spKt/V were 3.06 [interquartile range (IQR) 1.74-4.85] mL/min/1.73 m(2) and 1.32 +/- 0.28, respectively. A total of 7444 (23%) patients died during the median follow-up of 1.2 years (EQR 0.5-2.2 years) with an incidence of 15.4 deaths per 100 patientyears. The Cox model with adjustment for case-mix and laboratory variables showed that rCL(urea) modified the association between spKt/V and mortality (P-interaction = 0.03); lower spKt/V was associated with higher mortality among patients with low rCL urea (i.e.