Kumar Victoria A, Ledezma Mateo L, Idroos Mohammed L, Burchette Raoul J, Rasgon Scott A
Southern California Permanente Medical Group, Los Angeles, CA, USA.
Am J Kidney Dis. 2008 Oct;52(4):737-44. doi: 10.1053/j.ajkd.2008.06.013. Epub 2008 Aug 26.
Daily hemodialysis (DHD) is associated with improvements in hypertension, left ventricular hypertrophy, mineral metabolism, nutrition, and quality of life, but efficacy is uncertain because of potential selection bias. To reduce the influence of selection bias, we sought to compare hospital admissions for our population of DHD patients with peritoneal dialysis (PD) patients who initiated training during the same period. We also compared our hospital data with the US Renal Data Service database.
Prospective nonrandomized cohort study.
SETTING & PARTICIPANTS: 22 (16 male) DHD and 64 (33 male) PD patients who initiated training between March 2003 and September 2007 at our center and remained in our program for at least 6 months.
Dialysis modality (DHD or PD).
Number of hospital admissions and length of stay.
Median age at initiation of training was 52 years (range, 33 to 76 years) for DHD patients versus 54 years (range, 21 to 82 years) for PD patients (P = 0.5), and median vintage was 23 months (range, 0 to 145 months) for DHD patients versus 0 month (range, 0 to 244 months) for PD patients (P < 0.001). Fifty percent of DHD and 56% of PD patients had a diagnosis of diabetes mellitus (P = 0.8). We observed 27 DHD and 82 PD admissions (0.68 and 0.76 admissions/patient-year, respectively) during the study period (P = 0.5). We also observed 130 DHD and 605 PD hospital days (3.3 and 5.6 days/patient-year, respectively; P < 0.001).
Patients were not randomly assigned between the study group and control group; study group was small.
Our study suggests that despite similar patient demographics, patients treated with DHD spend fewer days in the hospital than PD patients in the United States. Although selection bias could partially explain our lower hospitalization rate, other factors, including improvements in blood pressure control, nutrition, and fewer fluctuations in dry weight, probably contributed to the stability of our patients.
每日血液透析（DHD）与高血压、左心室肥厚、矿物质代谢、营养状况及生活质量的改善相关，但由于存在潜在的选择偏倚，其疗效尚不确定。为减少选择偏倚的影响，我们试图比较DHD患者群体与同期开始腹膜透析（PD）培训的患者群体的住院情况。我们还将本中心的医院数据与美国肾脏数据服务数据库进行了比较。
前瞻性非随机队列研究。
2003年3月至2007年9月期间在本中心开始培训且在本项目中至少持续6个月的22例（16例男性）DHD患者和64例（33例男性）PD患者。
透析方式（DHD或PD）。
DHD患者开始培训时的中位年龄为52岁（范围33至76岁），PD患者为54岁（范围21至82岁）（P = 0.5）；DHD患者的中位透析时间为23个月（范围0至145个月），PD患者为0个月（范围0至244个月）（P < 0.001）。50%的DHD患者和56%的PD患者患有糖尿病（P = 0.8）。在研究期间，我们观察到27例DHD患者住院和82例PD患者住院（分别为0.68次/患者年和0.76次/患者年）（P = 0.5）。我们还观察到130个DHD患者住院日和605个PD患者住院日（分别为3.3天/患者年和5.6天/患者年；P < 0.001）。
研究组和对照组患者并非随机分配；研究组规模较小。
我们的研究表明，尽管患者人口统计学特征相似，但在美国接受DHD治疗的患者住院天数少于PD患者。虽然选择偏倚可能部分解释了我们较低的住院率，但其他因素，包括血压控制的改善、营养状况以及干体重波动较少，可能有助于维持我们患者的病情稳定。
