UK Renal Registry, Southmead Hospital, Bristol, UK.
Nephron Clin Pract. 2011;119 Suppl 2:c85-96. doi: 10.1159/000331754. Epub 2011 Aug 26.
Comorbidity is an important determinant of survival for renal replacement therapy patients and impacts other care processes such as dialysis access creation and transplant wait-listing. The prevalence of comorbidities in incident patients on renal replacement therapy (RRT) changes with age and varies between ethnic groups. This study describes these associations and the independent effect of comorbidities on outcomes.
Incident patients reported to the UK Renal Registry (UKRR) with comorbidity data in 2008 and 2009 (n = 5,617) were included in analyses exploring the association of comorbidity with patient demographics, treatment modality, haemoglobin and renal function at start of RRT. For analyses examining comorbidity and survival, adult patients starting RRT between 2004 and 2009 in centres reporting to the UKRR with comorbidity data (n = 16,527) were included. The relationship between comorbidities and mortality at 90 days and one year after 90 days from start of RRT was explored using Cox regression.
Completeness of comorbidity data was 44.4% in 2009 compared with 52.1% in 2004. Of patients with data, 56.5% had one or more comorbidities. Diabetes mellitus and ischaemic heart disease were the most common conditions seen in 32.9% and 22.5% of patients respectively. Current smoking was recorded for 12.4% of incident RRT patients in the 2-year period. The presence of comorbidities in patients <75 years became more common with increasing age in all ethnic groups. In multivariable survival analysis, malignancy and the presence of ischaemic/neuropathic ulcers were the strongest independent predictors of poor survival at 1 year after 90 days from the start of RRT in patients <65 years.
Differences in prevalence rates of comorbid illnesses in incident RRT patients may reflect variation in access to health care or competing risk prior to commencing treatment. The interpretation of analyses continues to be limited by poor data completeness.
合并症是影响接受肾脏替代治疗（RRT）患者生存的重要决定因素，并且会影响其他护理过程，如透析通路的建立和移植等候名单。在接受肾脏替代治疗的新发病例患者中，合并症的患病率随年龄而变化，并且在不同种族群体之间存在差异。本研究描述了这些关联以及合并症对结局的独立影响。
纳入了在 2008 年和 2009 年 UKRR 中报告有合并症数据的新发病例患者（n=5617），以分析合并症与患者人口统计学特征、治疗方式、RRT 起始时的血红蛋白和肾功能之间的关系。为了分析合并症与生存的关系，纳入了在 UKRR 报告中心接受 RRT 的年龄在 18 岁及以上、2004 年至 2009 年期间开始 RRT 且有合并症数据的患者（n=16527）。使用 Cox 回归分析了 RRT 起始后 90 天和 90 天后 1 年时合并症与死亡率之间的关系。
2009 年合并症数据的完整性为 44.4%，而 2004 年为 52.1%。在有数据的患者中，56.5%有一个或多个合并症。糖尿病和缺血性心脏病是最常见的疾病，分别占 32.9%和 22.5%的患者。在 2 年期间，有 12.4%的新发病例 RRT 患者正在吸烟。在所有种族群体中，<75 岁的患者中合并症的存在随着年龄的增加而变得更为常见。在多变量生存分析中，恶性肿瘤和缺血性/神经病变性溃疡的存在是<65 岁患者在 RRT 起始后 90 天后 1 年时生存不良的最强独立预测因素。
新发病例 RRT 患者合并症的患病率差异可能反映了治疗前获得医疗保健或竞争风险的差异。分析的解释仍然受到数据完整性差的限制。
