Selim G, Stojceva-Taneva O, Zafirovska K, Sikole A, Gelev S, Dzekova P, Stefanovski K, Koloska V, Polenakovic M
Department of Nephrology, Clinical Centre, Ss. Cyril and Methodius University, Skopje, R. Macedonia.
Prilozi. 2006 Jul;27(1):133-44.
Among non-traditional cardiovascular risk factors both malnutrition and inflammation appear to be strong predictors of mortality and morbidity in haemodialysis (HD) patients. Our study objective was to determine predictors of all-cause and cardiovascular mortality, considering the nutritional and immunologic parameters, in a cohort of HD patients treated in a single haemodialysis centre. 216 patients on HD were analyzed for clinical, nutritional-serum albumen and BMI, immunologic-serum CRP (C-reactive protein) and fibrinogen and dialysis parameters -- ultrafiltration, length of dialysis in hours, HD dose (using spKt/V and eKt/V). Mortality was monitored prospectively over a two-year period. Fifty-five of the 216 HD patients died during the follow-up period and the main cause of death was cardiovascular disease (CVD) -- 33 patients out of 55 (60%), followed by infection/sepsis (13 pts, 24%). The patients who died were significantly older, had a significantly shorter duration of HD in hours, ultrafiltration was significantly less, HD doses were significantly lower, as were serum levels of albumin (36.06 +/- 4.17 vs. 39.74 +/- 3.31; p=0.000) and Hg (93.14 +/- 15.43 vs. 109,16 +/- 12,08; p=0.000), but they had significantly higher serum levels of CRP (40.26 +/- 34.75 vs. 8.71 +/- 7.68, p=0.000) and fibrinogen (5.28 +/- 1.28 vs. 4.42 +/- 0.97, p=0.000). Kaplan-Meier survival estimates showed that the group with the lowest levels of albumin (< 3.5 g/L), and with the greatest levels of CRP (>20 mg/l) and fibrinogen (>5 g/L) had the lowest survival (log-rank test p=0.0008, p=0.00000, p=0.0000). However, in the Cox proportional hazards model, a high CRP and low Hg level (chi-square=96.467, p=0.0000) were predictors of all-cause mortality, whereas serum level of albumin did not show to be predictive. When only cardiovascular mortality is entered into the Cox model, CRP and Hg levels are still more important in predicting mortality (chi-square=70.055, p=0.0000) and only if CRP is not taken into account in the multivariate analysis, serum albumin level remains, after Hg, the strongest predictor for both overall and cardiovascular mortality (chi-square=76,564, p=0.0000; chi-square 50.619 p=0.0000). It can be concluded that inflammation predicted all-cause and cardiovascular mortality in our study group, because high CRP, as a marker of inflammation and low haemoglobin, as a result of inflammation, remained powerful predictors of both overall and cardiovascular death.
在非传统心血管危险因素中，营养不良和炎症似乎都是血液透析（HD）患者死亡率和发病率的有力预测因素。我们的研究目的是，在单个血液透析中心接受治疗的一组HD患者中，考虑营养和免疫参数，确定全因死亡率和心血管死亡率的预测因素。对216例HD患者进行了临床、营养指标（血清白蛋白和体重指数）、免疫指标（血清C反应蛋白（CRP）和纤维蛋白原）以及透析参数（超滤量、透析时长（小时）、HD剂量（使用标准化Kt/V和等效Kt/V））的分析。对患者进行了为期两年的前瞻性死亡监测。216例HD患者中有55例在随访期间死亡，主要死亡原因是心血管疾病（CVD）——55例中有33例（60%），其次是感染/脓毒症（13例，24%）。死亡患者年龄显著更大，HD时长（小时）显著更短，超滤量显著更少，HD剂量显著更低，血清白蛋白水平（36.06±4.17 vs. 39.74±3.31；p = 0.000）和血红蛋白水平（93.14±15.43 vs. 109.16±12.08；p = 0.000）也显著更低，但他们的血清CRP水平（40.26±34.75 vs. 8.71±7.68，p = 0.000）和纤维蛋白原水平（5.28±1.28 vs. 4.42±0.97，p = 0.000）显著更高。Kaplan-Meier生存估计显示，白蛋白水平最低（<3.5 g/L）、CRP水平最高（>20 mg/l）和纤维蛋白原水平最高（>5 g/L）的组生存率最低（对数秩检验p = 0.
