Nephrology Department, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
J Nephrol. 2012 Sep-Oct;25(5):672-8. doi: 10.5301/jn.5000038.
The aim of this study was to evaluate whether adherence to treatment is associated with hospitalization risk in hemodialysis patients.
We completed a cohort analysis of risk factors during 1 census month (November) and 1 year of follow-up during 5 consecutive years (2002-2006) in all end-stage renal disease patients hemodialyzed in the Kaunas region. During the census month, we collected data on noncompliance defined as (i) skipping of a hemodialysis (HD) session, (ii) shortening of 1 or more HD sessions, (iii) presence of hyperkalemia, (iv) presence of hyperphosphatemia, or (v) interdialytic weight gain (IDWG). In addition, data on age, sex, disability status, comorbidities, anemia control, malnutrition and inflammation, calcium-phosphorus metabolism and hospitalization rate were collected. Relative risk of hospitalization was estimated using Cox regression evaluating time to first hospitalization.
We analyzed 559 patients for a total of 1,163 patient-years during the 5 years of the study. On multivariate analysis, adjusting for ischemic heart disease, diabetes mellitus, higher number of comorbid conditions, higher systolic blood pressure before dialysis, worse disability status, lower hemoglobin, albumin and urea before dialysis, the relative risk for hospitalization increased by 1.1 for every additional percentage point of IDWG and by 1.19 with each 1 mmol/L rise of serum phosphorus level. Skipping or shortening of hemodialysis sessions and serum potassium level were not associated with hospitalization.
Higher IDWG and higher serum levels of phosphorus independently increased the relative risk of hospitalizations in hemodialysis patients. With skipped and shortened dialysis sessions, higher serum potassium level was not associated with hospitalization risk.
本研究旨在评估血液透析患者的治疗依从性与住院风险之间的关系。
我们对连续 5 年（2002-2006 年）每个月末（11 月）和随访 1 年的所有终末期肾病血液透析患者进行了队列分析。在普查月，我们收集了以下数据：定义为（i）漏透 1 次，（ii）缩短 1 次或多次，（iii）高钾血症，（iv）高磷血症，或（v）透析间期体重增加（IDWG）的不依从性。此外，还收集了年龄、性别、残疾状况、合并症、贫血控制、营养不良和炎症、钙磷代谢以及住院率等数据。使用 Cox 回归评估首次住院时间来估计住院的相对风险。
我们对 559 例患者进行了分析，共 1163 例患者年的研究时间为 5 年。在多变量分析中，调整了缺血性心脏病、糖尿病、更多合并症、透析前更高的收缩压、更差的残疾状况、更低的血红蛋白、白蛋白和尿素，IDWG 每增加 1 个百分点，住院的相对风险增加 1.1；血清磷水平每升高 1mmol/L，住院的相对风险增加 1.19。漏透和缩短透析时间与住院无关，血清钾水平与住院风险无关。
更高的 IDWG 和更高的血清磷水平独立增加了血液透析患者的住院相对风险。对于漏透和缩短透析时间，更高的血清钾水平与住院风险无关。
