Capelli J P, Kushner H, Camiscioli T, Chen S M, Stuccio-White N M
Department of Medicine, Our Lady of Lourdes Medical Center, Camden, N.J. 08103.
Am J Nephrol. 1992;12(4):212-23. doi: 10.1159/000168449.
The objective of this study was to analyze risk factors affecting mortality rates (MR) in hemodialysis patients undergoing shortened dialysis time who were regularly kinetically modeled. Over a 14-month period, 180 in-center hemodialysis patients, 54% male, 46% female, 57% Black, 39% Caucasian, and 4% Hispanic, treated with rapid high efficiency dialysis (RHED = 2-3 h, 3 times/week) and conventional dialysis (3-4 h, 3 times/week) were studied. Median patient age was 56.7 years (16-84 years) and dialysis care ranged from 6 months to 18 years (mean +/- SD = 4.0 +/- 4.2 years). The patients underwent monthly urea kinetic modeling. The dialysis prescription was based upon normalizing Kt/V between 0.8 and 1.2 and the protein catabolic rate (PCRn) between 0.9 and 1.1. Thirty-three percent of the patients received recombinant human erythropoietin (r-HuEPO). The effects of various covariates, including primary diagnosis, post/predialysis BUN ratios, creatinine, albumin, calcium, phosphate, cholesterol, hemoglobin, r-HuEPO, Kt/V, and PCRn were analyzed using analysis of variance, chi 2 and linear discriminant function (DF) statistical methods. Several significant factors emerged as influencing outcome. The DF analysis produced a highly statistically significant (p < 0.0001) model to predict mortality based upon certain laboratory and dialysis parameters. Further, the linear DF correctly predicted mortality rate in 86% of cases. The results of the analysis revealed an overall mortality rate of 15.6%; hospitalization rates (HR) were 1.4 +/- 1.8 times/year. Length of dialysis time, i.e., dialysis times between 2 and 4 h, when adjusted for Kt/V has no correlation with MR or HR. Variables associated with survival were higher post/predialysis BUN ratios, normal Kt/V (0.8-1.2), normal albumin levels (> 3.5 g/dl), higher postdialysis BUN, creatinine, and cholesterol levels, and use of r-HuEPO. The use of r-HuEPO when analyzed by DF significantly improved MR, 8.3% as opposed to 19.2%. It is concluded that urea kinetic modeling permits shortening dialysis times without affecting mortality or hospitalization rates, and that low postdialysis BUN, post/predialysis BUN ratios, creatinine, and albumin values are correlated with a lower chance of survival.
本研究的目的是分析影响接受缩短透析时间且定期进行动力学建模的血液透析患者死亡率（MR）的危险因素。在14个月的时间里，对180例中心血液透析患者进行了研究，其中男性占54%，女性占46%，黑人占57%，白种人占39%，西班牙裔占4%，这些患者接受快速高效透析（RHED = 2 - 3小时，每周3次）和常规透析（3 - 4小时，每周3次）。患者的中位年龄为56.7岁（16 - 84岁），透析治疗时间从6个月到18年不等（平均±标准差 = 4.0±4.2年）。患者每月进行尿素动力学建模。透析处方基于将Kt/V标准化在0.8至1.2之间以及蛋白质分解代谢率（PCRn）在0.9至1.1之间。33%的患者接受重组人促红细胞生成素（r - HuEPO）治疗。使用方差分析、卡方检验和线性判别函数（DF）统计方法分析了各种协变量的影响，包括原发性诊断、透析后/透析前尿素氮比值、肌酐、白蛋白、钙、磷、胆固醇、血红蛋白、r - HuEPO、Kt/V和PCRn。出现了几个影响预后的重要因素。DF分析产生了一个基于某些实验室和透析参数预测死亡率的具有高度统计学意义（p < 0.0001）的模型。此外，线性DF在86%的病例中正确预测了死亡率。分析结果显示总体死亡率为15.6%；住院率（HR）为每年1.4±1.8次。在根据Kt/V进行调整后，透析时间长度，即2至4小时之间的透析时间，与MR或HR无关。与生存相关的变量包括较高的透析后/透析前尿素氮比值、正常的Kt/V（0.8 - 1.2）、正常的白蛋白水平（> 3.5 g/dl）、较高的透析后尿素氮、肌酐和胆固醇水平以及r - HuEPO的使用。通过DF分析，r - HuEPO的使用显著改善了MR，从19.2%降至8.3%。结论是尿素动力学建模允许缩短透析时间而不影响死亡率或住院率，并且透析后低尿素氮、透析后/透析前尿素氮比值、肌酐和白蛋白值与较低的生存机会相关。
