World-wide, mortality is a high risk soon after initiation of hemodialysis
World-wide, mortality is a high risk soon after initiation of hemodialysis
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在世界范围内，开始血液透析后不久的死亡风险很高
作者：
B. Robinson;Jinyao Zhang;H. Morgenstern;B. Bradbury;L. Ng;K. McCullough;B. Gillespie;Raymond Hakim;H. Rayner;J. Fort;T. Akizawa;F. Tentori;R. Pisoni
维持性血液透析患者的死亡率比一般人群高得多，在开始透析后不久甚至更高。在这里，我们分析了11个国家的86,886例患者的死亡率模式，重点是使用透析结局和实践模式研究（一项中心血液透析的前瞻性队列研究）的数据进行早期透析。主要结局是全因死亡率，采用时间依赖性考克斯回归，按年龄、性别、种族和糖尿病校正的研究阶段分层。主要预测因素是透析开始后的时间，分为早期（最长120天）、中期（121-365天）和晚期（超过365天）。早期、中期和晚期的死亡率（死亡/100患者-年）分别为26.7（95%置信区间25.6，27.9）、16.9（16.2，17.6）和13.7（13.5，14.0）。在每个国家，死亡率在早期高于中期，调整后的范围从日本的3.10（2.22，4.32）到英国的1.15（0.87，1.53）。中期和后期调整后的死亡率相似。早期至中期死亡率升高的比率随着年龄的增长而增加。在每个时期内，美国的死亡率都高于大多数其他国家。因此，在国际上，早期血液透析期是所有研究国家的高风险时间，各国之间的死亡率存在显著差异。改善结果的努力应集中在过渡期和透析的最初几个月。
Mortality rates for maintenance hemodialysis patients are much higher than the general population and are even greater soon after starting dialysis. Here we analyzed mortality patterns in 86,886 patients in 11 countries focusing on the early dialysis period using data from the Dialysis Outcomes and Practice Patterns Study; a prospective cohort study of in-center hemodialysis. The primary outcome was all-cause mortality, using time-dependent Cox regression, stratified by study phase adjusted for age, sex, race, and diabetes. The main predictor was time since dialysis start as divided into early (up to 120 days), intermediate (121–365 days), and late (over 365 days) periods. Mortality rates (deaths/100 patient-years) were 26.7 (95% confidence intervals 25.6, 27.9), 16.9 (16.2, 17.6), and 13.7 (13.5, 14.0) in the early, intermediate, and late periods, respectively. In each country, mortality was higher in the early compared to the intermediate period with an adjusted range from 3.10 (2.22, 4.32) in Japan to 1.15 (0.87, 1.53) in the United Kingdom. Adjusted mortality rates were similar for intermediate and late periods. The ratio of elevated mortality rates in the early to the intermediate period increased with age. Within each period, mortality was higher in the United States than in most other countries. Thus, internationally, the early hemodialysis period is a high-risk time for all countries studied, with substantial differences in mortality between countries. Efforts to improve outcomes should focus on the transition period and first few months of dialysis.