UK Renal Registry, Bristol, UK.
Nephron Clin Pract. 2012;120 Suppl 1:c81-91. doi: 10.1159/000342846. Epub 2012 Sep 1.
Comorbidities are an important determinant of survival for patients requiring renal replacement therapy (RRT) and influence other care processes such as dialysis access formation and transplant wait-listing. The prevalence of comorbidities in incident RRT patients 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 2009 and 2010 (n = 6,130) were included in analyses exploring the association of comorbidities with patient demographics, treatment modality, haemoglobin and renal function at start of RRT. For analyses examining association between comorbidities and survival, adult patients starting RRT between 2005 and 2010 in centres reporting to the UKRR with comorbidity data (n = 17,184) were included. The relationship between comorbidities and mortality at 90 days and one year after 90 days from start of RRT were explored using Cox regression.
Completeness of comorbidity data was 49.1% in 2010 compared with 48.9% in 2005. Of patients with data, 55.4% had one or more comorbidities. Diabetes mellitus and ischaemic heart disease were the most common conditions, observed in 33.3% and 21.1% of patients respectively. 13.2% of incident RRT patients in the 2-year period were recorded as current smokers. The prevalence of comorbidity increased with increasing age across all ethnic groups. In multivariable survival analysis, malignancy and the presence of ischaemic/neuropathic ulcers were strong 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 generalisability of these analyses continues to be limited by poor data completeness.
合并症是需要肾脏替代治疗（RRT）的患者生存的重要决定因素，并影响其他护理过程，如透析通路的建立和移植等候名单。RRT 患者的合并症患病率随年龄而变化，并且在不同种族之间也有所不同。本研究描述了这些关联以及合并症对结果的独立影响。
2009 年和 2010 年，在 UKRR 中报告有合并症数据的 2009 年和 2010 年的 RRT 患者（n = 6,130）被纳入分析，以探讨合并症与患者人口统计学，治疗方式，RRT 开始时的血红蛋白和肾功能之间的关系。对于分析合并症与生存之间的关联，纳入 2005 年至 2010 年期间在 UKRR 报告中心开始 RRT 的成年患者（n = 17,184），并具有合并症数据。使用 Cox 回归分析了 RRT 开始后 90 天和 90 天后 1 年的合并症与死亡率之间的关系。
2010 年合并症数据的完整性为 49.1％，而 2005 年为 48.9％。在有数据的患者中，有 55.4％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，分别有 33.3％和 21.1％的患者患有该疾病。在这两年期间，有 13.2％的新 RRT 患者被记录为当前吸烟者。在所有种族中，随着年龄的增长，合并症的患病率均有所增加。在多变量生存分析中，在年龄<65 岁的患者中，恶性肿瘤和缺血性/神经源性溃疡的存在是 RRT 开始后 90 天后 1 年生存不良的独立强预测因素。
新 RRT 患者合并症发病率的差异可能反映了在开始治疗之前获得医疗保健的差异或竞争风险。这些分析的普遍性仍然受到数据完整性差的限制。
