Early Outcomes among Those Initiating Chronic Dialysis in the United States
Early Outcomes among Those Initiating Chronic Dialysis in the United States
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DOI：
10.2215/cjn.03680411
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发表时间：
2011-11-01
影响因子：
9.8
通讯作者：
Hakim, Raymond M.
中科院分区：
文献类型：
--
作者：
Chan, Kevin E.;Maddux, Frank W.;Hakim, Raymond M.
背景和目标在过去十年中，大约有一百万美国人开始进行慢性透析; 2007年美国肾脏数据系统报告的第一年死亡率为19.6%。这个估计在历史上排除了慢性dialysis.Design，设置，参与者，和测量的死亡率和住院风险的患者开始慢性肾脏替代治疗，我们跟踪所有患者开始透析在1733设施在美国（n = 303，289）。将前90天内的死亡率和住院率与此期间后的结果进行比较，并对结果进行分析。标准的时间序列分析被用来描述每周的风险估计为每个outcome.Results之间，1997年和2009年，> 300，000患者开始慢性透析，并遵循了> 3500万透析治疗，发病率和死亡率的最高风险发生在治疗的前2周。与长期透析第一年（开始后第53周）存活的患者相比，典型透析患者的初始2周死亡风险高2.72倍，住院风险高1.95倍。同样，在最初的90天里，死亡和住院的风险仍然很高。此后，在第91天至第365天之间，这些风险大大降低了一半以上。透析后最初几周的存活率与血管通路的类型最相关。结论慢性透析的前2周与死亡率和住院风险增加相关，在随后的90 d内，死亡率和住院风险仍然升高。Clin J Am Soc Nephrol 6：2642-2649，2011. doi：10.2215/CJN.03680411
Background and objectives Approximately one million Americans initiated chronic dialysis over the past decade; the first-year mortality rate reported by the U.S. Renal Data System was 19.6% in 2007. This estimate has historically excluded the first 90 days of chronic dialysis.Design, setting, participants, & measurements To characterize the mortality and hospitalization risks for patients starting chronic renal replacement therapy, we followed all patients initiating dialysis in 1733 facilities throughout the United States (n = 303,289). Mortality and hospitalizations within the first 90 days were compared with outcomes after this period, and the results were analyzed. Standard time-series analyses were used to depict the weekly risk estimates for each outcome.Results Between 1997 and 2009, >300,000 patients initiated chronic dialysis and were followed for >35 million dialysis treatments; the highest risk for morbidity and mortality occurred in the first 2 weeks of treatment. The initial 2-week risk of death for a typical dialysis patient was 2.72-fold higher, and the risk of hospitalization was 1.95-fold higher when compared to a patient who survived the first year of chronic dialysis (week 53 after initiation). Similarly, over the first 90 days, the risk of mortality and hospitalization remained elevated. Thereafter, between days 91 and 365, these risks decreased considerably by more than half. Surviving these first weeks of dialysis was most associated with the type of vascular access. Initiating dialysis with a fistula was associated with a decreased early death risk by 61%, whereas peritoneal dialysis decreased the risk by 87%.Conclusions The first 2 weeks of chronic dialysis are associated with heightened mortality and hospitalization risks, which remain elevated over the ensuing 90 days. Clin J Am Soc Nephrol 6: 2642-2649, 2011. doi: 10.2215/CJN.03680411