Medical Outpatient Department, Petersgraben 4, CH-4031 Basel.
Swiss Med Wkly. 2011 Feb 3;141:w13150. doi: 10.4414/smw.2011.13150. eCollection 2011.
Patient survival on chronic haemodialysis varies considerably among different countries and healthcare systems. To date, the survival of Swiss dialysis patients has not been analysed separately.
We consecutively enrolled 266 patients entering the chronic haemodialysis program of the University Hospital Basel between 01.01.1995 and 30.06.2006 into a cohort study. Patient survival on chronic haemodialysis was the primary endpoint. Pre-specified sub-group analyses were performed for female and diabetic patients.
Patient age ranged from 15 to 90 years. Seventy-two percent suffered either from coronary artery, peripheral artery or cerebrovascular disease and 34% from diabetes. Sixty-nine (26%) patients underwent kidney transplantation. Transplanted patients were significantly younger (p <0.01) and less likely to suffer from diabetes (p <0.01) and atherosclerotic diseases (coronary, peripheral, cerebrovascular p for all ≤0.01). Median survival was 4.25 years (95%CI 3.66-5.50), with one, three and five year survival rates reaching 88%, 68% and 46%. Survival rates were equal in men and women (p = 0.34), among diabetic and non-diabetic patients (p = 0.41) and among men and women stratified for the presence of diabetes (p = 0.13). Overall, 34% (91/266) patients died during the observational period. Thirty three percent of all deaths were caused by cardiac events, followed by malignant diseases (8%) and infections (7%). In 9% (23/266) dialysis was withdrawn and withdrawal of dialysis contributed to death in 25% (23/91).
Survival on chronic haemodialysis treatment in Switzerland compares favourably to international reference values. Dialysis withdrawal and the frequency of kidney transplantation impact long term patient outcome and should be adjusted for when comparing mortality analysis.
慢性血液透析患者的生存率在不同国家和医疗体系之间存在很大差异。迄今为止，瑞士透析患者的生存率尚未单独进行分析。
我们连续纳入了 1995 年 1 月 1 日至 2006 年 6 月 30 日期间进入巴塞尔大学医院慢性血液透析项目的 266 例患者，进行了一项队列研究。慢性血液透析患者的生存率为主要终点。对女性和糖尿病患者进行了预先指定的亚组分析。
患者年龄为 15 至 90 岁。72%的患者患有冠状动脉、外周动脉或脑血管疾病，34%的患者患有糖尿病。69 例（26%）患者接受了肾移植。移植患者明显更年轻（p <0.01），患糖尿病（p <0.01）和动脉粥样硬化疾病（冠状动脉、外周、脑血管疾病 p 均 <0.01）的可能性较小。中位生存时间为 4.25 年（95%CI 3.66-5.50），1、3 和 5 年生存率分别达到 88%、68%和 46%。男性和女性之间的生存率相同（p = 0.34），糖尿病患者和非糖尿病患者之间的生存率相同（p = 0.41），以及按是否存在糖尿病分层的男性和女性之间的生存率相同（p = 0.13）。在观察期间，共有 34%（91/266）的患者死亡。所有死亡中，33%是由心脏事件引起的，其次是恶性疾病（8%）和感染（7%）。9%（23/266）的患者停止了透析，其中 25%（23/91）的患者因停止透析而死亡。
瑞士慢性血液透析治疗的生存率与国际参考值相比表现良好。透析的停止和肾移植的频率影响长期患者结局，在比较死亡率分析时应予以调整。
