Prescription of twice-weekly hemodialysis in the MSA
Prescription of twice-weekly hemodialysis in the MSA
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DOI：
10.1159/000013533
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发表时间：
1999-11-01
影响因子：
4.2
通讯作者：
Daugirdas, JT
中科院分区：
文献类型：
--
作者：
Hanson, JA;Hulbert-Shearon, TE;Daugirdas, JT
背景/目的：本研究的目的是调查每周两次血液透析的频率和特征，以确定影响或预测该处方的因素，并检查每周接受两次血液透析的患者与每周三次的更常见治疗相比的结果。方法：利用来自 15,067 名成人血液透析患者的全国样本数据，通过逻辑回归对每周两次治疗与每周三次治疗进行比较。结果：治疗不到一年的患者比透析一年或一年以上的患者（2.7%）更有可能每周接受两次治疗（6.1%）（AOR = 1.49，p = 0.002）。不同地理区域的治疗方案也有很大差异。每周两次血液透析的预测因素（p < 0.05）包括年龄较大、白人种族、女性、较高的血清白蛋白、较低的血清肌酐水平和较低的体重指数。 ESRD 开始时较高的估计肾功能也预示着事件患者每周两次的治疗方案（AOR = 1.05，p = 0.05）。此外，Cox 调整生存分析表明，与每周三次血液透析相比，每周两次血液透析的死亡率风险较低（RR = 0.76，p = 0.02）。然而，对于突发事件患者，根据 ESRD 发病时的 GFR 进行调整后，结果并不显着（RR = 0.85，p = 0.31）。结论：所测量的特征仍然无法解释处方治疗的地理差异。每周两次血液透析的生存优势可能与患者选择和更大的残余肾功能有关。版权所有 (C) 1999 S. Karger AG，巴塞尔。
Background/Aims: The purpose of this study was to investigate the frequency and characteristics of two hemodialysis sessions/week, to identify factors which influence or predict this prescription, and to examine the outcomes of patients receiving hemodialysis two times/week as compared to the more common treatment of three times/week. Methods: Data from a national sample of 15,067 adult hemodialysis patients were utilized to compare twice-weekly with thrice-weekly therapy by logistic regression. Results: Patients treated less than one year were more likely to be treated twice-weekly (6.1%) than patients on dialysis for one year or more (2.7%) (AOR = 1.49, p = 0.002). Treatment schedules also varied significantly by geographic region. Factors predictive of twice-weekly hemodialysis (p < 0.05) were older age, Caucasian race, female gender, higher serum albumin, lower serum creatinine levels, and lower body mass index. A higher estimated renal function at the start of ESRD was also predictive of a twice-weekly schedule among incident patients (AOR = 1.05, p = 0.05). In addition, Cox-adjusted survival analysis indicated a lower mortality risk (RR = 0.76, p = 0.02) for twice-weekly hemodialysis compared to thrice-weekly among prevalent patients. For incident patients, however, the results were not significant when adjusted for GFR at ESRD onset (RR = 0.85, p = 0.31). Conclusion: Geographic differences in prescribed treatment remained unexplained by measured characteristics. The survival advantage associated with twice-weekly hemodialysis is likely to be related to patient selection and greater residual renal function. Copyright (C) 1999 S. Karger AG, Basel.