Wakasugi Minako, Kazama Junichiro James, Yamamoto Suguru, Kawamura Kazuko, Narita Ichiei
Center for Inter-organ Communication Research, Niigata University Graduate School of Medical and Dental Science, Asahimachi 1-757, Chuo-ku, Niigata 951-8510, Japan.
Ther Apher Dial. 2013 Jun;17(3):298-304. doi: 10.1111/j.1744-9987.2012.01144.x. Epub 2012 Dec 11.
Despite significant therapeutic advances, mortality of dialysis patients remains unacceptably high. The aim of this study is to compare mortality and its causes in dialysis patients with those in the general Japanese population. We used data for 2008 and 2009 from the Japanese Society for Dialysis Therapy registry and a national Vital Statistics survey. Cardiovascular mortality was defined as death attributed to heart failure, cerebrovascular disorders, myocardial infarction, hyperkalemia/sudden death, and pulmonary thromboembolism. Non-cardiovascular mortality was defined as death attributed to infection, malignancies, cachexia/uremia, chronic hepatitis/cirrhosis, ileus, bleeding, suicide/refusal of treatment, and miscellaneous. We calculated standardized mortality ratios and age-adjusted mortality differences between dialysis patients and the general population for all-cause, cardiovascular versus non-cardiovascular, and cause-specific mortality. During the 2-year study period, there were 2,284,272 and 51,432 deaths out of 126 million people and 273,237 dialysis patients, respectively. The standardized mortality ratio for all-cause mortality was 4.6 (95% confidence interval, 4.6-4.7) for the dialysis patients compared to the general population. Age-adjusted mortality differences for cardiovascular and non-cardiovascular disease were 33.1 and 30.0 per 1000 person-years, respectively. The standardized mortality rate ratios were significant for all cause-specific mortality rates except accidental death. Our study revealed that excess mortality in dialysis patients compared to the general population in Japan is large, and differs according to age and cause of death. Cause-specific mortality studies should be planned to improve life expectancies of dialysis patients.
尽管在治疗方面取得了重大进展，但透析患者的死亡率仍然高得令人难以接受。本研究的目的是比较透析患者与日本普通人群的死亡率及其原因。我们使用了日本透析治疗学会登记处2008年和2009年的数据以及一项全国生命统计调查。心血管死亡率定义为归因于心力衰竭、脑血管疾病、心肌梗死、高钾血症/猝死和肺血栓栓塞的死亡。非心血管死亡率定义为归因于感染、恶性肿瘤、恶病质/尿毒症、慢性肝炎/肝硬化、肠梗阻、出血、自杀/拒绝治疗及其他原因的死亡。我们计算了透析患者与普通人群在全因、心血管与非心血管以及特定病因死亡率方面的标准化死亡率比和年龄调整死亡率差异。在为期2年的研究期间，在1.26亿普通人群和273,237名透析患者中分别有死亡2,284,272例和51,432例。与普通人群相比，透析患者全因死亡率的标准化死亡率比为4.6（95%置信区间，4.6 - 4.7）。心血管疾病和非心血管疾病的年龄调整死亡率差异分别为每1000人年33.1和30.0。除意外死亡外，所有特定病因死亡率的标准化死亡率比均具有统计学意义。我们的研究表明，与日本普通人群相比，透析患者的超额死亡率很高，并且因年龄和死亡原因而异。应计划开展特定病因死亡率研究以提高透析患者的预期寿命。
