Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands.
PLoS One. 2013 Apr 19;8(4):e61155. doi: 10.1371/journal.pone.0061155. Print 2013.
We studied the distribution of causes of death in the CONTRAST cohort and compared the proportion of cardiovascular deaths with other populations to answer the question whether cardiovascular mortality is still the principal cause of death in end stage renal disease. In addition, we compared patients who died from the three most common death causes. Finally, we aimed to study factors related to dialysis withdrawal.
We used data from CONTRAST, a randomized controlled trial in 714 chronic hemodialysis patients comparing the effects of online hemodiafiltration versus low-flux hemodialysis. Causes of death were adjudicated. The distribution of causes of death was compared to that of the Dutch dialysis registry and of the Dutch general population.
In CONTRAST, 231 patients died on treatment. 32% died from cardiovascular disease, 22% due to infection and 23% because of dialysis withdrawal. These proportions were similar to those in the Dutch dialysis registry and the proportional cardiovascular mortality was similar to that of the Dutch general population. cardiovascular death was more common in patients <60 years. Patients who withdrew were older, had more co-morbidity and a lower mental quality of life at baseline. Patients who withdrew had much co-morbidity. 46% died within 5 days after the last dialysis session.
Although the absolute risk of death is much higher, the proportion of cardiovascular deaths in a prevalent end stage renal disease population is similar to that of the general population. In older hemodialysis patients cardiovascular and non-cardiovascular death risk are equally important. Particularly the registration of dialysis withdrawal deserves attention. These findings may be partly limited to the Dutch population.
我们研究了 CONTRAST 队列中死亡原因的分布，并将心血管死亡的比例与其他人群进行了比较，以回答在终末期肾病中心血管死亡率是否仍然是主要死亡原因的问题。此外，我们比较了死于三种最常见死因的患者。最后，我们旨在研究与透析退出相关的因素。
我们使用了 CONTRAST 的数据，这是一项在 714 名慢性血液透析患者中进行的随机对照试验，比较了在线血液透析滤过与低通量血液透析的效果。死因经过裁决。将死因分布与荷兰透析登记处和荷兰一般人群进行了比较。
在 CONTRAST 中，231 名患者在治疗期间死亡。32%死于心血管疾病，22%因感染，23%因透析退出。这些比例与荷兰透析登记处和荷兰一般人群相似。心血管死亡率与荷兰一般人群相似。心血管死亡在<60 岁的患者中更为常见。退出的患者年龄更大，基线时合并症更多，心理健康状况较差。退出的患者合并症更多。46%在最后一次透析后 5 天内死亡。
尽管绝对死亡风险要高得多，但在普遍存在的终末期肾病患者中，心血管死亡的比例与一般人群相似。在老年血液透析患者中，心血管和非心血管死亡风险同样重要。特别是透析退出的登记应该引起重视。这些发现可能部分仅限于荷兰人口。
