Sikole A, Nikolov V, Dzekova P, Stojcev N, Amitov V, Selim G, Asani A, Gelev S, Grozdanovski R, Masin G, Klinkmann H, Polenakovic M
Clinic of Nephrology, Medical Faculty, Skopje, R. Macedonia.
Prilozi. 2007 Dec;28(2):99-110.
Patient survival is a key index of the overall adequacy of treatment in most chronic diseases. Analyses of survival of patients undergoing haemodialysis is very important, as it may offer clues and ideas for prolonging survival of patients with end-stage renal disease (ESRD). The aims of this study were to describe the characteristics of the patients on maintenance haemodialysis therapy over a period of 20 years, to determine the survival rate of these patients according to ages at the onset of haemodialysis, the primary renal diseases, and the cause of death, and to determine the survival rate at five, ten, fifteen and twenty years of haemodialysis treatment at our centre. The charts of 518 unselected patients, 282 male and 236 female, treated with maintenance haemodialysis therapy in a period of 20 years (1985-2005) were reviewed. At the time of evaluation, 164 patients were currently being treated, and 354 patients overall had been diseased. Statistical analysis was performed to evaluate the relationship between survival and patient characteristics such as age, gender, primary renal disease, and age at dialysis onset. Actual survival rates were determined by the Kaplan-Meier method. The survival rate of our patients treated with maintenance haemodialysis was 60% at 5 years, 37% at 10 years, 25% at 15 years and 9% at 20 years. Female patient survival was superior to male. Patients aged under 40 at the start of dialysis had a better survival probability compared to older patients. Patients with diabetes mellitus and nephroangiosclerosis, had a lower survival rate compared to patients with glomerulonephritis and with adult dominant polycystic kidney disease. Cardiac death was the most common cause of death in patients involved in the study. About 52% of the patients died from cardiovascular disease. Death is the most severe consequence of inadequate dialysis and can be used as an index of the adequacy of the dialysis therapy. Treatment factors that may improve outcomes include an early start of dialysis therapy, a high dose of dialysis (Kt/V over 1.2), correction of anemia, adequate protein and caloric intake, control of calcium and phosphate metabolism, and the use of biocompatible dialyzers.
患者生存率是大多数慢性疾病整体治疗充分性的关键指标。分析接受血液透析患者的生存率非常重要，因为这可能为延长终末期肾病（ESRD）患者的生存期提供线索和思路。本研究的目的是描述20年间维持性血液透析治疗患者的特征，根据血液透析开始时的年龄、原发性肾脏疾病和死亡原因确定这些患者的生存率，并确定在本中心进行血液透析治疗5年、10年、15年和20年时的生存率。回顾了1985年至2005年这20年间接受维持性血液透析治疗的518例未经挑选患者的病历，其中男性282例，女性236例。在评估时，有164例患者正在接受治疗，总共有354例患者患病。进行统计分析以评估生存率与患者特征（如年龄、性别、原发性肾脏疾病和透析开始时的年龄）之间的关系。实际生存率采用Kaplan-Meier方法确定。接受维持性血液透析治疗的患者5年生存率为60%，10年生存率为37%，15年生存率为25%，20年生存率为9%。女性患者的生存率高于男性。透析开始时年龄在40岁以下的患者比老年患者有更好的生存概率。与患有肾小球肾炎和成人显性多囊肾病的患者相比，患有糖尿病和肾血管硬化的患者生存率较低。心脏死亡是参与研究患者中最常见的死亡原因。约52%的患者死于心血管疾病。死亡是透析不充分最严重的后果，可作为透析治疗充分性的指标。可能改善预后的治疗因素包括早期开始透析治疗、高剂量透析（Kt/V超过1.2）、纠正贫血、充足的蛋白质和热量摄入、控制钙磷代谢以及使用生物相容性透析器。
