Abbott Kevin C, Bucci Jay R, Agodoa Lawrence Y
Nephrology Service, Walter Reed Army Medical Center, Washington, DC, USA.
J Nephrol. 2003 Jan-Feb;16(1):34-9.
The national incidence of and factors associated with total hip arthroplasty (THA) in chronic dialysis patients has never been reported.
We therefore performed an historical cohort study of 375,857 chronic dialysis patients listed in the 2000 United States Renal Data System between 1 April 1995 and 31 December 1999 and followed-up until 14 May 2000. Primary outcomes were associations with hospitalizations for a primary discharge code of THA (ICD9 procedure code 81.51x) after initiation of dialysis.
Dialysis patients had a cumulative incidence of THA of 35 episodes/10,000 person-years, compared to 5.3/10,000 in the general population. The leading indication for THA was osteoarthritis of the hip and pelvis (58% of cases). However, the strongest risk factor for THA in dialysis patients was end-stage renal disease (ESRD) due to systemic lupus erythematosus (SLE, adjusted rate ratio (ARR), 6.80, 95% CI 4.62-10.03, in whom avascular necrosis of the hip was the most common indication, 68.4%). The database did not include information on use of corticosteroids. Diabetic recipients were significantly less likely to receive THA, as were males, and African Americans. Mortality after THA was 0.25% at thirty days and 30% at three years, not significantly different from the expected mortality of dialysis, adjusted for comorbidity.
The most common indication for THA in dialysis patients is osteoarthritis of the hip, similar to the general population. Patients with SLE are more likely to receive THA which is well tolerated and not associated with increased mortality in this population, perhaps reflecting selection bias due to appropriate screening for this elective procedure.
慢性透析患者全髋关节置换术（THA）的全国发病率及相关因素此前从未有过报道。
因此，我们对1995年4月1日至1999年12月31日期间列入2000年美国肾脏数据系统的375,857例慢性透析患者进行了一项历史性队列研究，并随访至2000年5月14日。主要结局是透析开始后因THA主要出院编码（ICD9手术编码81.51x）住院的相关因素。
透析患者THA的累积发病率为35例/10,000人年，而普通人群为5.3/10,000。THA的主要指征是髋部和骨盆骨关节炎（58%的病例）。然而，透析患者中THA的最强危险因素是系统性红斑狼疮（SLE）导致的终末期肾病（ESRD）（调整后的发病率比（ARR）为6.80，95%可信区间为4.62 - 10.03），其中髋部缺血性坏死是最常见的指征，占68.4%。数据库未包括使用皮质类固醇的信息。糖尿病患者接受THA的可能性显著较低，男性和非裔美国人也是如此。THA术后30天死亡率为0.25%，3年死亡率为30%，与经合并症调整后的透析预期死亡率无显著差异。
透析患者THA最常见的指征是髋部骨关节炎，与普通人群相似。SLE患者更有可能接受THA，且耐受性良好，在该人群中与死亡率增加无关，这可能反映了由于对该择期手术进行适当筛查而导致的选择偏倚。
