Impact of dialysis dose and membrane on infection-related hospitalization and death: Results of the HEMO study
Impact of dialysis dose and membrane on infection-related hospitalization and death: Results of the HEMO study
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DOI：
10.1097/01.asn.0000074237.78764.d1
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发表时间：
2003-07-01
影响因子：
13.6
通讯作者：
Schwab, SJ
中科院分区：
文献类型：
--
作者：
Allon, M;Depner, TA;Schwab, SJ
感染是血液透析患者死亡的第二大常见原因。HEMO研究的预定次要目的是确定透析剂量或流量是否减少感染相关死亡或住院。使用考克斯回归分析分析透析剂量、透析膜和其他临床参数对感染相关死亡和首次感染相关住院的影响。在1846例随机患者（平均年龄58岁; 56%为女性; 63%为黑人; 45%为糖尿病患者）中，有871例死亡，其中201例（23%）死于感染。有1698例感染相关住院，年发病率为35%。感染相关死亡的可能性在随机分配到高剂量或标准剂量的患者之间（相对风险[RR]，0.99 [0.75 - 1.31]）或随机分配到高通量或低通量膜的患者之间（RR，0.85 [0.64 - 1.13]）没有差异。感染相关死亡的相对风险与年龄（RR，1.47 [1.29 - 1.68]/10年）、共病评分（RR，1.46 [1.21 - 1.76]）和血清白蛋白（RR，0.19 [0.09 - 0.41]/g/dl）相关（每个变量P < 0.001）。21%的病例首次感染相关住院与血管通路相关，79%的病例与非通路相关。在因入路相关感染而入院的所有研究患者中，有32%的患者使用了导管，尽管导管仅占研究中血管入路的7.6%。总之，感染几乎占死亡人数的四分之一。高剂量或高通量透析器并未降低透析相关死亡。在这项前瞻性研究中，大多数感染相关的住院并不归因于血管通路。然而，与移植物或瘘管相比，导管患者的穿刺相关、感染相关住院率不成比例地更高。
Infection is the second most common cause of death among hemodialysis patients. A predefined secondary aim of the HEMO study was to determine if dialysis dose or flux reduced infection-related deaths or hospitalizations. The effects of dialysis dose, dialysis membrane, and other clinical parameters on infection-related deaths and first infection-related hospitalizations were analyzed using Cox regression analysis. Among the 1846 randomized patients (mean age, 58 yr; 56% female; 63% black; 45% with diabetes), there were 871 deaths, of which 201 (23%) were due to infection. There were 1698 infection-related hospitalizations, yielding a 35% annual rate. The likelihood of infection-related death did not differ between patients randomized to a high or standard dose (relative risk [RR], 0.99 [0.75 to 1.31]) or between patients randomized to high-flux or low-flux membranes (RR, 0.85 [0.64 to 1.13]). The relative risk of infection-related death was associated (P < 0.001 for each variable) with age (RR, 1.47 [1.29 to 1.68] per 10 yr); co-morbidity score (RR, 1.46 [1.21 to 1.76]), and serum albumin (RR, 0.19 [0.09 to 0.41] per g/dl). The first infection-related hospitalization was related to the vascular access in 21% of the cases, and non-access-related in 79%. Catheters were present in 32% of all study patients admitted with access-related infection, even though catheters represented only 7.6% of vascular accesses in the study. In conclusion, infection accounted for almost one fourth of deaths. Infection-related deaths were not reduced by higher dose or by high flux dialyzers. In this prospective study, most infection-related hospitalizations were not attributed to vascular access. However, the frequency of access-related, infection-related hospitalizations was disproportionately higher among patients with catheters compared with grafts or fistulas.