Rydell Helena, Krützen Lena, Simonsen Ole, Clyne Naomi, Segelmark Mårten
Department of Nephrology and Transplantation, Skane University Hospital; Department of Clinical Sciences, Lund University, Lund.
Hemodial Int. 2013 Oct;17(4):523-31. doi: 10.1111/hdi.12046. Epub 2013 Apr 11.
Survival for patients on dialysis is poor. Earlier reports have indicated that home-hemodialysis is associated with improved survival but most of the studies are old and report only short-time survival. The characteristics of patient populations are often incompletely described. In this study, we report long-term survival for patients starting home-hemodialysis as first treatment and estimate the impact on survival of age, comorbidity, decade of start of home-hemodialysis, sex, primary renal disease and subsequent renal transplantation. One hundred twenty-eight patients starting home-hemodialysis as first renal replacement therapy 1971-1998 in Lund were included. Data were collected from patient files, the Swedish Renal Registry and Swedish census. Survival analysis was made as intention-to-treat analysis (including survival after transplantation) and on-dialysis-treatment analysis with patients censored at the day of transplantation. Ten-, twenty- and thirty-year survival were 68%, 36% and 18%. Survival was significantly affected by comorbidity, age and what decade the patients started home-hemodialysis. For patients younger than 60 years and with no comorbidities, the corresponding figures were 75%, 47% and 23% and a subsequent renal transplantation did not significantly influence survival. Long-term survival for patients starting home-hemodialysis is good, and improves decade by decade. Survival is significantly affected by patient age and comorbidity, but the contribution of subsequent renal transplantation was not significant for younger patients without comorbidities.
接受透析治疗的患者生存率较低。早期报告表明，家庭血液透析与生存率提高相关，但大多数研究较为陈旧，仅报告了短期生存率。患者群体的特征往往描述不完整。在本研究中，我们报告了首次接受家庭血液透析治疗患者的长期生存率，并评估了年龄、合并症、开始家庭血液透析的年代、性别、原发性肾脏疾病以及后续肾移植对生存率的影响。纳入了1971年至1998年在隆德首次接受家庭血液透析作为首次肾脏替代治疗的128例患者。数据从患者档案、瑞典肾脏登记处和瑞典人口普查中收集。生存分析采用意向性治疗分析（包括移植后的生存情况）以及在移植日对患者进行截尾的透析治疗分析。10年、20年和30年生存率分别为68%、36%和18%。生存率受到合并症、年龄以及患者开始家庭血液透析的年代的显著影响。对于年龄小于60岁且无合并症的患者，相应数字分别为75%、47%和23%，后续肾移植对生存率没有显著影响。首次接受家庭血液透析治疗患者的长期生存率良好，且逐十年提高。生存率受到患者年龄和合并症的显著影响，但对于年龄较小且无合并症的患者，后续肾移植的影响不显著。
