Physical Resilience Phenotype Trajectories in Incident Hemodialysis: Characterization and Mortality Risk Assessment.
Physical Resilience Phenotype Trajectories in Incident Hemodialysis: Characterization and Mortality Risk Assessment.
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新发血液透析患者身体恢复力表型轨迹：特征描述与死亡风险评估
DOI：
10.1016/j.ekir.2022.06.009
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发表时间：
2022-09
影响因子：
6
通讯作者：
Bandeen-Roche, Karen
中科院分区：
文献类型：
--
作者：
Hladek, Melissa D.;Zhu, Jiafeng;Crews, Deidra C.;McAdams-DeMarco, Mara A.;Buta, Brian;Varadhan, Ravi;Shafi, Tariq;Walston, Jeremy D.;Bandeen-Roche, Karen
虽然可以挽救生命，但开始血液透析的生理压力会导致一些患者的身体损伤。开始血液透析后的死亡风险评估尚不完善，并且没有考虑随时间的变化。身体弹性的测量，即生理状态克服生理应激源的能力，可能有助于识别死亡风险较高的患者并为临床管理提供信息。我们使用在针对 394 名 55 岁以上成年人的 ESKD 健康结果选择 (CHOICE) 研究中开始血液透析后第一年收集的 SF-36 数据，为 4 个表型（身体功能 [PF]、心理健康 [MH]、活力 [VT] 和一般健康 [GH]）的轨迹创建了 3 个复原力类别（改善、稳定和下降）。使用混合效应和 Cox 比例风险模型，我们根据每种表型的恢复力类别评估了透析第一年的死亡率，调整了基线表型和其他先验定义的 4 年平均随访的混杂因素。根据全球 Wald 检验，发现 PF (P = 0.03) 和 VT (P = 0.0004) 弹性类别与死亡率之间存在统计显着关联，且与协变量无关。与稳定轨迹相比，PF 轨迹下降与较高的死亡风险相关（风险比 [HR] = 1.32；95% 置信区间 [CI]，1.05–1.66），而 VT 轨迹改善与较低的死亡风险相关（HR= 0.73；95% CI，0.53 至 1.00）。 PF 和 VT 恢复力下降与死亡率独立相关。在评估死亡率时，表型轨迹为基线标记和患者特征提供了附加值。因此，复原力措施有望针对最高风险患者进行人口健康干预。
Although life-saving, the physiologic stress of hemodialysis initiation contributes to physical impairment in some patients. Mortality risk assessment following hemodialysis initiation is underdeveloped and does not account for change over time. Measures of physical resilience, the ability of a physiologic state to overcome physiologic stressors, may help identify patients at higher mortality risk and inform clinical management. We created 3 resilience categories (improving, stable, and declining) for trajectories of 4 phenotypes (physical function [PF], mental health [MH], vitality [VT], and general health [GH]) using SF-36 data collected the first year after hemodialysis initiation in the Choices for Healthy Outcomes in Caring for ESKD (CHOICE) study on 394 adults aged more than 55 years. Using mixed effects and Cox proportional hazard modeling, we assessed mortality following the first year on dialysis by resilience categories for each phenotype, adjusting for baseline phenotype and other confounders defined a priori over 4 years average follow-up. Based on global Wald tests, statistically significant associations of PF (P = 0.03) and VT (P = 0.0004) resilience categories with mortality were found independent of covariates. Declining PF trajectory was associated with higher mortality risk (hazard ratio [HR] = 1.32; 95% confidence interval [CI], 1.05–1.66), whereas improving VT trajectory was associated with lower mortality risk (HR= 0.73; 95% CI, 0.53 to 1.00), each as compared to stable trajectory. Decreased resilience in PF and VT was independently associated with mortality. Phenotypic trajectories provide added value to baseline markers and patient characteristics when evaluating mortality. Hence, resilience measures hold promise for targeting population health interventions to the highest risk patients.
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影响因子：
39.2
作者：
Kinchen, KS;Sadler, J;Powe, NR
通讯作者：
Powe, NR
影响因子：
41.5
作者：
Kooman, Jeroen P.;Kotanko, Peter;Stenvinkel, Peter
通讯作者：
Stenvinkel, Peter
影响因子：
13.6
作者：
Astor, BC;Eustace, JA;Coresh, J
通讯作者：
Coresh, J
预测透析和保守护理的死亡率风险：针对患有晚期慢性肾脏疾病的老年患者的预测工具的开发和内部验证。
影响因子：
4.6
作者：
Ramspek CL;Verberne WR;van Buren M;Dekker FW;Bos WJW;van Diepen M
通讯作者：
van Diepen M
影响因子：
3.9
作者：
Ramspek CL;Voskamp PW;van Ittersum FJ;Krediet RT;Dekker FW;van Diepen M
通讯作者：
van Diepen M