Mauri J M, Vela E, Clèries M
Nephrology Department, Josep Trueta Teaching Hospital, Girona, Spain.
Acta Diabetol. 2008 Dec;45(4):203-9. doi: 10.1007/s00592-008-0043-x. Epub 2008 Aug 8.
The aim of this study was to investigate whether early death following the start of dialysis treatment can be explained by predialysis comorbid conditions, and to develop a prognostic model to predict early death in these patients. All patients with diabetes mellitus (DM) over 19 years of age entering hemodialysis in Catalonia in the 1997-2002 period (n = 1,365) were assessed from prospectively obtained data in the Catalan Renal Registry. Logistic regression was used to identify the risk factors associated with mortality at 3, 6 and 12 months of hemodialysis. Mortality at 3 months was found to be associated with age (RR: 1.53/10 years), low grades of functional autonomy, defined as "limited" (RR: 2.28) or "special care" (RR: 4.60), heart disease (RR: 2.23), and use of a catheter as the first vascular access (RR: 2.45). Malignant conditions and malnutrition were found to be additional significant risk factors for mortality at 12 months (RR: 1.68 and 1.74, respectively). Based on the multivariate analysis results, an individual prognostic model was formulated. This study confirms previous data suggesting that predialysis comorbid conditions are significantly associated with mortality in DM patients on dialysis and provides a prognostic model to help clinicians focus on various factors that may require attention before initiating this treatment.
本研究的目的是调查透析治疗开始后的早期死亡是否可由透析前的合并症来解释，并建立一个预测模型来预测这些患者的早期死亡。对1997年至2002年期间在加泰罗尼亚开始进行血液透析的所有19岁以上糖尿病（DM）患者（n = 1365），根据加泰罗尼亚肾脏登记处前瞻性获取的数据进行评估。采用逻辑回归来确定与血液透析3个月、6个月和12个月时死亡率相关的危险因素。发现3个月时的死亡率与年龄（风险比：每10年1.53）、功能自主性低分级（定义为“受限”，风险比：2.28；或“特殊护理”，风险比：4.60）、心脏病（风险比：2.23）以及使用导管作为首次血管通路（风险比：2.45）有关。恶性疾病和营养不良被发现是12个月时死亡率的另外两个显著危险因素（风险比分别为1.68和1.74）。基于多变量分析结果，制定了一个个体预后模型。本研究证实了先前的数据，表明透析前的合并症与透析的糖尿病患者的死亡率显著相关，并提供了一个预后模型，以帮助临床医生关注开始这种治疗前可能需要注意的各种因素。
