ERA–EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Nephrol Dial Transplant. 2010 Dec;25(12):3836-9. doi: 10.1093/ndt/gfq540. Epub 2010 Sep 10.
Patients with chronic kidney disease (CKD) who live up to renal replacement therapy (RRT) are a selected group of patients with a high mortality risk. The aim of this paper is to contribute a potential epidemiological explanation as to why therapeutic interventions - targeting specific causes of death - of which the effectiveness has been shown in the general population may not have a similar impact in a highly selected population like RRT patients. In this perspective, selection processes over the course of renal disease progression as well as the potential 'dilution' of an effect in the presence of highly increased mortality from other causes need attention. We suggest that the results from well-conducted high-quality studies in incident RRT patients without or with only very limited in- and exclusion criteria are likely the ones best qualified to be extrapolated to other RRT populations.
患有慢性肾病（CKD）且尚未进行肾脏替代治疗（RRT）的患者是一组具有高死亡率风险的特定患者。本文旨在提供一个潜在的流行病学解释，说明为什么针对特定死亡原因的治疗干预措施——其在普通人群中的有效性已得到证实——在像 RRT 患者这样高度选择的人群中可能没有类似的影响。从这个角度来看，需要关注肾脏疾病进展过程中的选择过程，以及在其他原因导致的死亡率极高的情况下效果的“稀释”。我们建议，对没有或只有非常有限的纳入和排除标准的新发生 RRT 患者进行的高质量研究的结果，最有可能被推断到其他 RRT 人群中。
