Fink J C, Gardner J F, Armistead N C, Turner M S, Light P D
Department of Medicine, University of Maryland School of Medicine, Baltimore 21201-1595, USA.
J Clin Epidemiol. 2000 Jan;53(1):79-85. doi: 10.1016/s0895-4356(99)00129-8.
The purpose of this study was to determine whether patients with end stage renal disease treated with hemodialysis were correlated in dialysis adequacy within facilities. This was a retrospective analysis of dialysis adequacy based on urea reduction ratio (URR) values from 6969 patients dialyzed at 154 facilities. The within-center correlation was quantified using the between-center variation and the parameter p that was derived using ANOVA tables and mixed effects models. The variation in center means for URR was wider than expected for independent observations (52.9-76.1 versus 60.7-73.8, respectively). Furthermore, there was a significant within-center correlation in URR values across all facilities (p = 0.136, P<0.0001), which persisted after adjusting for patient specific covariates, facility characteristics, and state. In conclusion, there was a substantial within-center correlation in dialysis adequacy that reflected important center effects on the outcome of ESRD patients.
本研究的目的是确定接受血液透析治疗的终末期肾病患者在各医疗机构内的透析充分性是否相关。这是一项基于154家医疗机构中6969例接受透析患者的尿素清除率（URR）值对透析充分性进行的回顾性分析。使用中心间变异以及通过方差分析表和混合效应模型得出的参数p对中心内相关性进行量化。URR中心均值的变异比独立观察预期的更宽（分别为52.9 - 76.1与60.7 - 73.8）。此外，所有医疗机构的URR值存在显著的中心内相关性（p = 0.136，P<0.0001），在对患者特定协变量、医疗机构特征和州进行调整后该相关性仍然存在。总之，透析充分性存在显著的中心内相关性，这反映了医疗机构对终末期肾病患者结局的重要影响。
