High-Performance Membrane Dialyzers and Mortality in Hemodialysis Patients: A 2-Year Cohort Study from the Annual Survey of the Japanese Renal Data Registry
High-Performance Membrane Dialyzers and Mortality in Hemodialysis Patients: A 2-Year Cohort Study from the Annual Survey of the Japanese Renal Data Registry
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DOI：
10.1159/000478032
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发表时间：
2017-01-01
影响因子：
4.2
通讯作者：
Masakane, Ikuto
中科院分区：
文献类型：
--
作者：
Abe, Masanori;Hamano, Takayuki;Masakane, Ikuto
背景：关于能带来良好预后的透析器类型的信息很少。本研究旨在调查 7 种类型的透析器与 2 年死亡率之间的关联。方法：我们利用日本透析治疗学会全国登记处的数据进行了一项队列研究。受试者为 2009 年至 2011 年间接受维持性血液透析 (HD) 的 136,676 名患者，他们接受维持性血液透析至少 2 年，并接受以下 7 种高性能膜透析器之一治疗：三醋酸纤维素 (CTA)、乙烯乙烯醇 (EVAL)、聚丙烯腈 (PAN)、聚酯聚合物合金 (PEPA)、聚醚砜 (PES)、聚甲基丙烯酸甲酯（PMMA）和聚砜（PS）。 Cox 回归用于估计基线透析器与全因 2 年死亡率之间的关联，并调整潜在的混杂因素。结果：采用基本因素对数据进行调整，以PS为参考组，CTA、PMMA、PAN、EVAL组的风险比（HR）显着较高。对 Kt/N 的进一步数据调整产生了与根据基本因素调整的数据获得的相同结果。进一步调整营养和炎症相关因素后，与PS组相比，PES和PMMA组的HR显着降低（分别为HR 0.88；95% CI 0.82-0.94和HR 0.84 95% CI 0.76-0.93）。倾向评分匹配后，PES组和PMMA组的HR显着低于PS组。结论：使用不同类型的膜可能会影响死亡率。需要进一步的长期前瞻性研究来阐明PES和PMMA膜是否可以改善预后。 (C) 2017 S. Karger AG，巴塞尔。
Background: Little information is available regarding the type of dialyzer which results in good prognosis. This study is aimed at investigating the association between 7 types of dialyzers and 2-year mortality. Methods: We conducted a cohort study using data from a nationwide registry of the Japanese Society for Dialysis Therapy. Subjects were 136,676 patients on maintenance hemodialysis (HD) between 2009 and 2011 who underwent maintenance HD for at least 2 years and were treated with one of the following 7 types of high-performance membrane dialyzers: cellulose triacetate (CTA), ethylene vinyl alcohol (EVAL), polyacrylonitrile (PAN), polyester polymer alloy (PEPA), polyethersulfone (PES), polymethylmethacrylate (PMMA), and polysulfone (PS). Cox regression was used to estimate the association between baseline dialyzers and all-cause 2-year mortality, adjusting for potential confounders. Results: Data were adjusted using basic factors, with PS as a reference group, and the hazard ratio (HR) was significantly higher in CTA, PMMA, PAN, and EVAL groups. Further data adjustment for Kt/N yielded the same results as were obtained from data adjusted for basic factors. After further adjustment for nutrition- and inflammation-related factors, HR was significantly lowered for the PES and PMMA groups compared with the PS group (HR 0.88; 95% CI 0.82-0.94 and HR 0.84 95% CI 0.76-0.93, respectively). After propensity score matching, HR for the PES and PMMA groups was significantly lowered compared with the PS group. Conclusions: The use of different membrane types may affect mortality. Further long-term prospective studies are needed to clarify whether the PES and PMMA membranes can improve prognosis. (C) 2017 S. Karger AG, Basel.