Cruz J M, Piera L, Bragg-Gresham J L, Feldman H, Port F K
Servicio de Nefrología, Hospital General Universitario La Fe, Avda. Campanar, 21, 46009 Valencia, España.
Nefrologia. 2003 Sep-Oct;23(5):437-43.
The Dialysis Outcomes and Practice Pattern Study (DOPPS) is an international observational study of treatment conditions and medical outcomes in hemodialysis patients. Prospective sampling has yielded long-term observational data from randomly selected groups of patients receiving treatment at representative, randomly selected hemodialysis units in each country. The data shown were collected at 20 hemodialysis units/centers in Spain. The data pertaining to Spain--Sp--refers to 575 patients and their comparison with those of the Euro-DOPPS countries--Eu--(Germany, France, United Kingdom, Italy and Spain), which encompass 3,038 patients, represent the formal goal of this paper. Diabetes mellitus, at 21.5% in Eu and 21.7% in Sp, was the most common cause of renal insufficiency in dialysis and coronariopathy, as a concomitant disease, was present in 67.8% in Eu as opposed to 75.8% in Sp. Differences were observed in the incident of hypertension (73.4% in Eu vs 77.4% in Sp), hepatitis C (11.6% vs 19.5%), depression (12.7 vs 16.2%) and left ventricular hypertrophy (54.9% vs 62.3%). The patterns of vascular access were similar (79% vs 81% AV fistulas in Eu and Sp, and 10% synthetic grafts for both) and the mean applied dose of dialysis--Kt/V--smaller (1.19) in Sp than in Eu (1.24); likewise the duration of the dialysis (in minutes) was shorter (234 in Eu vs 217 in Sp) and the % of synthetic membranes used was smaller (60% in Eu vs 52% in Sp). There were no differences between the groups in the figures for urea, creatinine, albumin, nPCR, calcium, phosphate or PTH. There were also no differences in the mean values of Hb (10.7 for Eu vs 10.8 for Sp), given that the values of ferritin were noticeably lower in Sp (288 vs 355) and the dose of EPO/kg/week was higher to in Sp (115 vs 102); s.c. route was used in similar proportions (69% in Eu vs 67% in Sp). The level of medical care, understood as contact with the physician at all or almost all treatments, was noticeably better in Sp (90%) that in Eu (66%), whereas the number of patients per hour of specialized personnel and % of specialized staff, were smaller. Mortality (death/100 patients-years) was one point lower in Sp than in Eu (15.4 vs 16.3). These data suggest that an increment in dialysis time and in the percentage of synthetic membranes used, as well as in the supply of intravenous iron, would be justified.
透析结果与实践模式研究（DOPPS）是一项针对血液透析患者治疗状况和医疗结果的国际观察性研究。前瞻性抽样已从每个国家具有代表性的、随机选择的血液透析单位中接受治疗的随机选择患者组中得出长期观察数据。所示数据是在西班牙的20个血液透析单位/中心收集的。与西班牙相关的数据（Sp）涉及575名患者，并将其与欧洲DOPPS国家（Eu，包括德国、法国、英国、意大利和西班牙）的3038名患者的数据进行比较，这是本文的正式目标。糖尿病在Eu中占21.5%，在Sp中占21.7%，是透析中肾功能不全最常见的原因，而作为伴随疾病的冠心病在Eu中占67.8%，在Sp中占75.8%。在高血压（Eu中为73.4%，Sp中为77.4%）、丙型肝炎（11.6%对19.5%）、抑郁症（12.7对16.2%）和左心室肥厚（54.9%对62.3%）的发生率上观察到差异。血管通路模式相似（Eu和Sp中动静脉内瘘分别为79%和81%，两者人工血管均为10%），西班牙的平均透析剂量——Kt/V——（1.19）低于Eu（1.24）；同样，透析时间（分钟）较短（Eu中为234，Sp中为217），使用的合成膜百分比也较小（Eu中为60%，Sp中为52%）。两组在尿素、肌酐、白蛋白、nPCR、钙、磷或甲状旁腺激素的数据上没有差异。Hb的平均值也没有差异（Eu为10.7，Sp为10.8），因为西班牙的铁蛋白值明显较低（288对355），而西班牙的促红细胞生成素/kg/周剂量较高（115对102）；皮下注射途径的使用比例相似（Eu中为69%，Sp中为67%）。医疗护理水平，即几乎所有治疗都与医生接触，在西班牙（90%）明显高于Eu（66%），而每小时专业人员护理的患者数量和专业人员百分比则较低。西班牙的死亡率（死亡/100患者-年）比Eu低1个百分点（15.4对16.3）。这些数据表明，增加透析时间、合成膜使用百分比以及静脉铁供应是合理的。
