Predialysis Kidney Function and Its Rate of Decline Predict Mortality and Hospitalizations After Starting Dialysis.
Predialysis Kidney Function and Its Rate of Decline Predict Mortality and Hospitalizations After Starting Dialysis.
复制标题
透析前肾功能及其下降率可预测开始透析后的死亡率和住院率。
DOI：
10.1016/j.mayocp.2018.01.030
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发表时间：
2018
影响因子：
8.9
通讯作者：
Kalantar-Zadeh,Kamyar
中科院分区：
文献类型：
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作者：
Soohoo,Melissa;Streja,Elani;Obi,Yoshitsugu;Rhee,ConnieM;Gillen,DanielL;Sumida,Keiichi;Nguyen,DanhV;Kovesdy,CsabaP;Kalantar-Zadeh,Kamyar
目的确定在过渡到终末期肾病（ESRD）的退伍军人中，肾功能水平及其在透析前即刻的下降率是否预测透析后死亡率和住院率。患者和方法在2007年10月1日至2014年3月30日期间过渡到ESRD的19，985名退伍军人中，我们检查了ESRD前期最后一年的肾功能及其斜率。将低与高估计肾小球滤过率（eGFR，在10 mL/min/1.73 m2处二分）和慢斜率与快斜率（在−10 mL/min/1.73 m2/y处二分）两个类别合并为4组。他们与12个月后终末期肾病全因和心血管（CV）死亡率和住院率的关系在调整后的模型中进行了检查，该模型考虑了过渡期的临床特征和实验室测量结果。过渡和斜率时的中位（四分位距）eGFR分别为9.7（7.1-13.3）mL/min/1.73 m2和−10.5（−18.8至−5.9）mL/min/1.73 m2/y。eGFR低和斜率慢的患者的12个月全因和CV死亡风险和住院率最低。相反，与eGFR低和斜率慢的患者相比，eGFR高和斜率快的患者的全因和CV死亡率和住院率风险最高。这种关系持续在敏感性分析，包括倾向scoring.ConclusionA肾配置文件的低eGFR和缓慢的斜率在前奏期间与有利的早期透析结果在退伍军人患者。有必要进行试验以检查更保守的透析方法。
ObjectiveTo determine whether kidney function level and its rate of decline in the immediate predialysis period among veterans transitioning to end-stage renal disease (ESRD) predict postdialysis mortality and hospitalization.Patients and MethodsIn 19,985 veterans transitioning to ESRD during the period October 1, 2007, to March 30, 2014, we examined kidney function and its slope over the final year of the pre-ESRD(prelude) period. Two categories of low vs high estimated glomerular filtration rate (eGFR, dichotomized at 10 mL/min/1.73 m2) and slow vs fast slope (dichotomized at −10 mL/min/1.73 m2/y) were combined into 4 groups. Their associations with 12-month post-ESRD all-cause and cardiovascular (CV) mortality and hospitalization rates were examined in adjusted models accounting for clinical characteristics and laboratory measurements at transition.ResultsPatients, 66±11 years old, and 34% blacks, had a median (interquartile range) eGFR at transition and slope of 9.7 (7.1-13.3) mL/min/1.73 m2and −10.5 (−18.8 to −5.9) mL/min/1.73 m2/y, respectively. Patients with a low eGFR and slow slope had the lowest 12-month all-cause and CV mortality risks and hospitalization rate. Conversely, patients with high eGFR and fast slope had the highest risk of all-cause and CV mortality and hospitalization rate compared with patients with a low eGFR and slow slope. This relationship persisted in sensitivity analyses, including propensity scoring.ConclusionA kidney profile of a low eGFR and slow slope in the prelude period is associated with favorable early dialysis outcomes in veteran patients. Trials to examine a more conservative approach to dialysis are warranted.