Renal division, Stadtspital Waid, Zurich, Switzerland.
BMC Nephrol. 2012 Jul 2;13:52. doi: 10.1186/1471-2369-13-52.
Long term longitudinal data are scarce on epidemiological characteristics and patient outcomes in patients on maintenance dialysis, especially in Switzerland. We examined changes in epidemiology of patients undergoing renal replacement therapy by either hemodialysis or peritoneal dialysis over four decades.
Single center retrospective study including all patients which initiated dialysis treatment for ESRD between 1970 and 2008. Analyses were performed for subgroups according to dialysis vintage, based on stratification into quartiles of date of first treatment. A multivariate model predicting death and survival time, using time-dependent Cox regression, was developed.
964 patients were investigated. Incident mean age progressively increased from 48 ± 14 to 64 ± 15 years from 1st to 4th quartile (p < 0.001), with a concomitant decrease in 3- and 5-year survival from 72.2 to 67.7%, and 64.1 to 54.8%, respectively. Nevertheless, live span continuously increased from 57 ± 13 to 74 ± 11 years (p < 0.001). Patients transplanted at least once were significantly younger at dialysis initiation, with significantly better survival, however, shortened live span vs. individuals remaining on dialysis. Among age at time of initiating dialysis therapy, sex, dialysis modality and transplant status, only transplant status is a significant independent covariate predicting death (HR: 0.10 for transplanted vs. non-transplanted patients, p = 0.001). Dialysis vintage was associated with better survival during the second vs. the first quartile (p = 0.026).
We document an increase of a predominantly elderly incident and prevalent dialysis population, with progressively shortened survival after initiation of renal replacement over four decades, and, nevertheless, a prolonged lifespan. Analysis of the data is limited by lack of information on comorbidity in the study population.
Survival in patients on renal replacement therapy seems to be affected not only by medical and technical advances in dialysis therapy, but may mostly reflect progressively lower mortality of individuals with cardiovascular and metabolic complications, as well as a policy of accepting older and polymorbid patients for dialysis in more recent times. This is relevant to make demographic predictions in face of the ESRD epidemic nephrologists and policy makers are facing in industrialized countries.
在接受维持性透析治疗的患者中，长期纵向数据在流行病学特征和患者结局方面都很匮乏，尤其在瑞士。我们研究了在过去四十年中，通过血液透析或腹膜透析进行肾脏替代治疗的患者的流行病学变化。
这是一项单中心回顾性研究，纳入了 1970 年至 2008 年间所有开始接受终末期肾病透析治疗的患者。根据首次治疗日期的四分位分层，对透析时龄亚组进行分析。使用时间依赖性 Cox 回归建立了一个预测死亡和生存时间的多变量模型。
共纳入 964 例患者。从第 1 四分位到第 4 四分位，首发透析的患者年龄从 48±14 岁逐渐增加到 64±15 岁（p＜0.001），同时 3 年和 5 年生存率从 72.2%降至 67.7%，64.1%降至 54.8%。然而，生存跨度从 57±13 岁持续增加到 74±11 岁（p＜0.001）。至少接受过一次移植的患者在开始透析时年龄明显较小，且生存率明显较高，但与继续接受透析的患者相比，生存跨度较短。在开始透析治疗时的年龄、性别、透析方式和移植状态等因素中，只有移植状态是预测死亡的独立显著协变量（与未移植患者相比，移植患者的 HR：0.10，p=0.001）。与第 1 四分位相比，第 2 四分位的生存时间更长（p=0.026）。
我们记录了一个主要由老年患者组成的新发和现患透析人群的增加，在过去四十年中，在开始肾脏替代治疗后，患者的生存时间逐渐缩短，但寿命延长。由于研究人群中缺乏合并症信息，因此对数据的分析受到限制。
接受肾脏替代治疗的患者的生存率不仅受到透析治疗的医学和技术进步的影响，而且可能主要反映出心血管和代谢并发症患者的死亡率逐渐降低，以及最近接受更多老年和合并多种疾病患者进行透析治疗的政策。这与面对工业化国家的肾脏流行病，肾病学家和政策制定者所面临的人口预测有关。
