Saudan Patrick, Kossovsky Michel, Halabi George, Martin Pierre Y, Perneger Thomas V
Division of Nephrology, University Hospital, 1211 Geneva 14, Switzerland.
Nephrol Dial Transplant. 2008 Jun;23(6):1975-81. doi: 10.1093/ndt/gfm915. Epub 2007 Dec 22.
Many factors affect survival in haemodialysis (HD) patients. Our aim was to study whether quality of clinical care may affect survival in this population, when adjusted for demographic characteristics and co-morbidities.
We studied survival in 553 patients treated by chronic HD during March 2001 in 21 dialysis facilities in western Switzerland. Indicators of quality of care were established for anaemia control, calcium and phosphate product, serum albumin, pre-dialysis blood pressure (BP), type of vascular access and dialysis adequacy (spKt/V) and their baseline values were related to 3-year survival. The modified Charlson co-morbidity index (including age) and transplantation status were also considered as a predictor of survival.
Three-year survival was obtained for 96% of the patients; 39% (211/541) of these patients had died. The 3-year survival was 50, 62 and 69%, respectively, in patients who had 0-2, 3 and >or=4 fulfilled indicators of quality of care (test for linear trend, P < 0.001). In a Cox multivariate analysis model, the absence of transplantation, a higher modified Charlson's score, decreased fulfilment of indicators of good clinical care and low pre-dialysis systolic BP were independent predictors of death.
Good clinical care improves survival in HD patients, even after adjustment for availability of transplantation and co-morbidities.
许多因素影响血液透析（HD）患者的生存率。我们的目的是研究在调整人口统计学特征和合并症后，临床护理质量是否会影响该人群的生存率。
我们研究了2001年3月在瑞士西部21个透析机构接受慢性血液透析治疗的553例患者的生存率。建立了贫血控制、钙磷乘积、血清白蛋白、透析前血压（BP）、血管通路类型和透析充分性（spKt/V）等护理质量指标，并将其基线值与3年生存率相关联。改良的Charlson合并症指数（包括年龄）和移植状态也被视为生存的预测指标。
96%的患者获得了3年生存率；其中39%（211/541）的患者死亡。护理质量指标达标数为0 - 2、3和≥4的患者，其3年生存率分别为50%、62%和69%（线性趋势检验，P < 0.001）。在Cox多变量分析模型中，未进行移植、较高的改良Charlson评分、良好临床护理指标达标率降低以及透析前收缩压较低是死亡的独立预测因素。
即使在调整移植可用性和合并症后，良好的临床护理仍可提高血液透析患者的生存率。
