Preservation of glomerular filtration rate on dialysis when adjusted for patient dropout.
Preservation of glomerular filtration rate on dialysis when adjusted for patient dropout.
复制标题
根据患者退出情况进行调整后，维持透析时的肾小球滤过率。
DOI：
10.1046/j.1523-1755.2000.00891.x
复制
发表时间：
2000
影响因子：
19.6
通讯作者：
K. Nolph
中科院分区：
文献类型：
--
作者：
M. Misra;M. Misra;M. Misra;E. Vonesh;E. Vonesh;E. Vonesh;D. Churchill;D. Churchill;D. Churchill;H. Moore;H. Moore;H. Moore;J. Stone;J. Stone;J. Stone;K. Nolph;K. Nolph;K. Nolph
背景
残余肾功能（RRF）在透析患者中起着重要作用。在维持性透析患者中进行的研究表明，与接受血液透析（HD）的患者维斯，接受腹膜透析（PD）的患者的RRF保存更好。我们推测，无论患者的治疗类型如何，由于与患者脱落相关的信息删失，获得的肾小球滤过率（GFR）下降率估计值可能存在偏倚。信息性删失发生在死亡或很早就转入另一种治疗方式的患者与完成研究或死亡或转入较晚的患者相比，其起始GFR较低或GFR下降率较高。如果患者脱落确实与GFR下降率相关，并且如果在分析中忽略这种关系，则获得的GFR下降率估计值可能存在偏倚。
方法
为了确定患者脱落与GFR下降之间是否存在关系，我们通过将GFR建模为时间的非线性函数（下降率为指数），重新分析了CANUSA数据。
结果
本文强调了在研究透析时RRF下降时“信息删失”的重要性。结果表明，对于CANUSA队列，死亡或转入HD的患者的平均初始GFR显著低于随机删失或接受移植的患者，并且下降率显著高于随机删失或接受移植的患者。重要的是要强调，目前尚不清楚信息删失对先前PD与HD之间RRF下降分析的影响。如果无论患者接受何种治疗，信息性删失引起的偏倚相同，则既往研究中比较PD和HD之间GFR下降的结论仍然有效。然而，如果偏倚的大小因治疗而异，则需要进行额外的调整，以公平地比较PD和HD之间的GFR下降。由于该分析仅限于PD患者，因此仅根据该分析的结果解释既往研究在科学上是不正确的。
结论
在任何旨在估计一段时间内测量的结局趋势的纵向研究中，重要的是数据分析要考虑患者脱落可能对估计趋势产生的任何影响。该分析表明，在PD患者中，起始GFR和GFR下降率均与患者脱落相关。因此，未来旨在估计PD患者GFR下降率的研究也应考虑脱落与GFR之间的任何依赖性。同样，PD和HD之间GFR下降率明显差异的数据分析也应调整可能的信息删失。
BACKGROUND
Residual renal function (RRF) plays an important role in dialysis patients. Studies in patients on maintenance dialysis suggest that RRF is better preserved in patients receiving peritoneal dialysis (PD) vis-à-vis those receiving hemodialysis (HD). We speculated that regardless of the patient's type of therapy, the estimate obtained for the rate of decline in glomerular filtration rate (GFR) may be biased because of informative censoring associated with patient dropout. Informative censoring occurs when patients who die or transfer to another modality very early have associated with them a lower starting GFR or a higher rate of decline of GFR than patients who either complete the study or who die or transfer much later. If patient dropout is indeed related to the rate of decline in GFR and if this relationship is ignored in the analysis, then the estimate obtained of the rate of decline in GFR may be biased.
METHODS
In an attempt to determine if there is a relationship between patient dropout and the decline in GFR, we reanalyzed the CANUSA data by modeling GFR as a nonlinear function of time with the rate of decline being exponential.
RESULTS
This article highlights the significance of "informative censoring" when studying the decline of RRF on dialysis. The results show that for the CANUSA cohort, the mean initial GFR was significantly lower, and the rate of decline was significantly higher for patients who died or transferred to HD than for patients who were randomly censored or received a transplant. It is important to emphasize that the impact of informative censoring on previous analyses of the decline of RRF between PD versus HD is presently unclear. If bias caused by informative censoring is the same regardless of what therapy a patient is on, then conclusions from previous studies comparing the decline in GFR between PD and HD would still be valid. However, if the magnitude of the bias differs according to therapy, then additional adjustments would be needed to fairly compare the decline in GFR between PD and HD. Because this analysis is restricted to patients on PD, it would be scientifically incorrect to interpret previous studies solely on the basis of the results from this analysis.
CONCLUSION
In any longitudinal study designed to estimate trends in an outcome measured over time, it is important that the analysis of the data takes into account any effect patient dropout may have on the estimated trend. This analysis demonstrates that among PD patients, both the starting GFR and the rate of decline in GFR are associated with patient dropout. Consequently, future studies aimed at estimating the rate of decline in GFR among PD patients should also account for any dependencies between dropout and GFR. Similarly, data analyzing for apparent differences in the rate of decline of GFR between PD and HD should also adjust for possible informative censoring.