Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.
Clin J Am Soc Nephrol. 2009 Oct;4(10):1620-8. doi: 10.2215/CJN.01750309. Epub 2009 Sep 3.
The aim of the investigation presented here was to compare the rates, causes, and timing of cardiovascular (CV) death in incident peritoneal dialysis (PD) and hemodialysis (HD) patients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The study included all adult Australian and New Zealand patients commencing dialysis between January 1, 1997 and December 31, 2007. Rates of and times to CV death were compared by incident rate ratios, cumulative incidence, and multivariable Cox proportional hazards model analyses. Dialysis modality was included in the model as a time-varying covariate, and a competing risks approach was used to obtain cause-specific hazard ratios.
Of the 24,587 patients who commenced dialysis (first treatment PD n = 6521; HD n = 18,066) during the study, 5669 (21%) died from CV causes [PD 2044 (28%) versus HD 3625 (21%)]. The incidence rates of CV mortality in PD and HD patients were 9.99 and 7.96 per 100 patient-years, respectively (incidence rate ratio PD versus HD, 1.25; 95% confidence interval 1.12 to 1.32). PD was consistently associated with an increased hazard of CV death compared with HD after 1 yr of treatment. This increased risk in PD patients was largely accounted for by an increased risk of death due to myocardial infarction.
Dialysis modality is significantly associated with the risk, causes, and timing of CV death experienced by ESRD patients in Australia and New Zealand.
本研究旨在比较新进入腹膜透析（PD）和血液透析（HD）患者的心血管（CV）死亡率、原因和时间。
设计、设置、参与者和测量：该研究包括所有在 1997 年 1 月 1 日至 2007 年 12 月 31 日期间开始透析的澳大利亚和新西兰成年患者。通过发病率比值、累积发病率和多变量 Cox 比例风险模型分析比较 CV 死亡的发生率和时间。透析方式作为一个时变协变量包含在模型中，使用竞争风险方法获得特定原因的风险比。
在研究期间开始透析的 24587 名患者中（首次治疗 PD 组 n=6521，HD 组 n=18066），有 5669 名（21%）死于 CV 原因[PD 组 2044 名（28%）与 HD 组 3625 名（21%）]。PD 和 HD 患者 CV 死亡率的发生率分别为 9.99 和 7.96/100 患者年，PD 与 HD 相比，发病率比值为 1.25（95%置信区间 1.12 至 1.32）。在治疗 1 年后，PD 与 HD 相比，PD 始终与 CV 死亡风险增加相关。PD 患者的这种风险增加主要归因于心肌梗死导致的死亡风险增加。
在澳大利亚和新西兰，透析方式与 ESRD 患者的 CV 死亡风险、原因和时间显著相关。
