1] United States Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, USA [2] Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
United States Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, USA.
Kidney Int. 2014 Aug;86(2):392-8. doi: 10.1038/ki.2014.15. Epub 2014 Feb 12.
Clinical experience suggests a heightened risk associated with the transition to maintenance dialysis but few national studies have systematically examined early mortality trajectories. Here we calculated weekly mortality rates in the first year of treatment for 498,566 adults initiating maintenance dialysis in the United States (2005-2009). Mortality rates were initially unexpectedly low, peaked at 37.0 per 100 person-years in week 6, and declined steadily to 14.8 by week 51. In both early (weeks 7-12) and later (weeks 13-51) time frames, multivariate mortality associations included older age, female, Caucasian, non-Hispanic ethnicity, end-stage renal disease (ESRD) from hypertension and acute tubular necrosis, ischemic heart disease, estimated glomerular filtration rate of 15 ml/min per 1.73 m(2) or more, shorter duration of nephrologist care, and hemodialysis, especially with a catheter. For early mortality risk, adjusted hazard ratios of 2 or more were seen with age over 65 (5.80 vs. under 40 years), hemodialysis with a catheter (2.73 vs. fistula), and age 40-64 (2.33). For later mortality risk, adjusted hazard ratios of 2 or more were seen with age over 65 (4.32 vs. under 40 years), hemodialysis with a catheter (2.10 vs. fistula), and age 40-64 (2.00). Thus, low initial mortality rates question the accuracy of data collected and are consistent with deaths occurring in the early weeks after starting dialysis not being registered with the United States Renal Data System.
临床经验表明，与过渡到维持性透析相关的风险增加，但很少有国家研究系统地检查早期死亡率轨迹。在这里，我们计算了 498566 名在美国开始维持性透析的成年人在治疗的第一年中的每周死亡率（2005-2009 年）。死亡率最初出人意料地低，在第 6 周达到每 100 人年 37.0 的峰值，然后稳定下降至第 51 周的 14.8。在早期（第 7-12 周）和晚期（第 13-51 周）时间段，多变量死亡率关联包括年龄较大、女性、白种人、非西班牙裔种族、终末期肾病（ESRD）由高血压和急性肾小管坏死、缺血性心脏病、估计肾小球滤过率为 15ml/min/1.73m(2)或更高、接受肾病医生治疗的时间较短以及血液透析，尤其是带导管的血液透析。对于早期死亡率风险，年龄超过 65 岁（5.80 与 40 岁以下）、带导管的血液透析（2.73 与瘘管）和 40-64 岁的年龄（2.33）与调整后的危险比为 2 或更高。对于晚期死亡率风险，年龄超过 65 岁（4.32 与 40 岁以下）、带导管的血液透析（2.10 与瘘管）和 40-64 岁的年龄（2.00）与调整后的危险比为 2 或更高。因此，最初死亡率较低的问题是数据收集的准确性，并与开始透析后几周内发生的死亡未在美国肾脏数据系统中登记的情况一致。
