Yamagata Kunihiro, Nakai Shigeru, Masakane Ikuto, Hanafusa Norio, Iseki Kunitoshi, Tsubakihara Yoshiharu
Department of Nephrology, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Ther Apher Dial. 2012 Feb;16(1):54-62. doi: 10.1111/j.1744-9987.2011.01005.x. Epub 2011 Nov 3.
Previous studies have suggested that early initiation of dialysis therapy was not superior in terms of patient survival. In this study, we analyzed the effects of renal function at the start of renal replacement therapy (RRT), duration of nephrology care, and comorbidity on 12-month survival of end-stage renal disease (ESRD) patients. The subjects in this study were 9695 new ESRD patients who started RRT in 2007. The average age of the subjects was 67.5 years, 64.1% of the subjects were male, and 42.9% had diabetes. During the 12-month period after the start of RRT, 1546 patients died, and 35 patients received renal transplantation. Average estimated glomerular filtration rate (eGFR) at the initiation of dialysis was 6.52 ± 4.20 mL/min/1.73 m(2) . By unadjusted logistic analysis, one-year Odds Ratio (OR) of mortality in patients with eGFR more than 4-6 mL/min/1.73 m(2) was increased with increased eGFR at dialysis initiation, but the OR was identical among the groups with eGFR less than 4 mL/min/1.73 m(2) . After adjustment for age, gender, underlying renal diseases, and other clinical characteristics at dialysis initiation, OR was identical among the groups with eGFR less than 8 mL/min/1.73 m(2) . Furthermore, an OR increment was observed in eGFR less than 4 mL/min/1.73 m(2) group. In terms of the duration of nephrology care before dialysis initiation, 6 months or longer of nephrology care significantly decreased the OR of mortality after adjustment of covariance. Not only patients with sufficient residual renal function at the initiation of dialysis, but also patients with very low eGFR at the initiation of dialysis showed poor survival.
既往研究表明，早期开始透析治疗在患者生存方面并无优势。在本研究中，我们分析了肾脏替代治疗（RRT）开始时的肾功能、肾病护理时长及合并症对终末期肾病（ESRD）患者12个月生存率的影响。本研究的受试者为2007年开始接受RRT的9695例新发ESRD患者。受试者的平均年龄为67.5岁，64.1%为男性，42.9%患有糖尿病。在开始RRT后的12个月期间，1546例患者死亡，35例患者接受了肾移植。透析开始时的平均估计肾小球滤过率（eGFR）为6.52±4.20 mL/min/1.73 m²。未经校正的逻辑分析显示，透析开始时eGFR大于4 - 6 mL/min/1.73 m²的患者，其1年死亡比值比（OR）随透析开始时eGFR升高而增加，但eGFR小于4 mL/min/1.73 m²的各组之间OR相同。在对年龄、性别、潜在肾脏疾病及透析开始时的其他临床特征进行校正后，eGFR小于8 mL/min/1.73 m²的各组之间OR相同。此外，eGFR小于4 mL/min/1.73 m²组的OR出现升高。就透析开始前的肾病护理时长而言，在协方差校正后，6个月或更长时间的肾病护理显著降低了死亡OR。不仅透析开始时残余肾功能充足的患者，而且透析开始时eGFR极低的患者生存率也较差。
