The Association between Dialysis Dose and Risk of Cancer Death in Patients Undergoing Hemodialysis: The Q-Cohort Study
The Association between Dialysis Dose and Risk of Cancer Death in Patients Undergoing Hemodialysis: The Q-Cohort Study
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DOI：
10.2169/internalmedicine.4027-19
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发表时间：
2020-01-01
影响因子：
1.2
通讯作者：
Kitazono, Takanari
中科院分区：
文献类型：
--
作者：
Hara, Masatoshi;Tanaka, Shigeru;Kitazono, Takanari
目的 尿毒症毒素是血液透析 (HD) 患者患癌症的已知危险因素。虽然充分清除尿毒症毒素可能会通过改善亚临床尿毒症来降低癌症风险，但透析剂量与接受 HD 的患者癌症死亡风险之间的关系仍不清楚。 方法 在这项前瞻性观察性研究中，对 3,450 名接受 HD 的患者进行了为期 4 年的随访。主要结局是癌症死亡。根据基线 Kt/V 水平将患者分为四分位数。使用Kaplan-Meier法和Cox比例风险模型估计Kt/V水平与癌症死亡风险之间的关联。结果在4年观察期内共有111名患者（3.2%）死于癌症。 4 年生存率随着 KtN 的降低而线性下降。与最高 Kt/V 类别的患者相比，四分位数 (Q)1、Q2 和 Q3 中癌症死亡的多变量调整风险比 (HR) 和 95% 置信区间 (CI) 分别为 2.23 (95% CI，1.13-4.56)、1.77 (0.88-3.63) 和 1.89 (1.04-3.56) (Q4)（趋势 p = 0.06）。 Kt/V 每增加 0.1，癌症死亡风险就会降低 8%（HR 0.92，95% CI，0.85-0.99）。结论 对于接受 HD 的患者，较低的透析剂量可能与较高的癌症死亡风险相关。 Kt/V 是临床实践中使用的透析剂量的简单指标，可能是预测癌症死亡风险的有用的可修改因素。需要进一步的基础和介入研究来证实与增加透析剂量相关的癌症死亡明显减少。
Objective Uremic toxins are known risk factors for cancer in patients undergoing hemodialysis (HD). Although adequate removal of uremic toxins might reduce the cancer risk by improving subclinical uremia, the relationship between the dialysis dose and risk of cancer death in patients undergoing HD remains unclear.Methods In this prospective observational study, 3,450 patients undergoing HD were followed up for 4 years. The primary outcome was cancer death. Patients were divided into quartiles according to their baseline Kt/V levels. The association between the Kt/V levels and risk of cancer death was estimated using the Kaplan-Meier method and Cox proportional-hazards model.Results A total of 111 patients (3.2%) died from cancer during the 4-year observational period. The 4-year survival rate decreased linearly with decreasing KtN. The multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer death were 2.23 (95% CI, 1.13-4.56), 1.77 (0.88-3.63), and 1.89 (1.04-3.56) in quartile (Q)1, Q2, and Q3, respectively, compared with patients in the highest Kt/V category (Q4) (p for trend = 0.06). Every 0.1 increase in Kt/V was associated with a reduction of 8% in cancer death (HR 0.92, 95% CI, 0.85-0.99).Conclusion A lower dialysis dose might be associated with a higher risk of cancer death in patients undergoing HD. Kt/V is a simple indicator of dialysis dose used in clinical practice and might be a useful modifiable factor for predicting the risk of cancer death. Further basic and interventional studies are needed to confirm the apparent reduction in cancer death associated with increasing the dialysis dose.