Neovius Martin, Jacobson Stefan H, Eriksson Jonas K, Elinder Carl-Gustaf, Hylander Britta
Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
BMJ Open. 2014 Feb 18;4(2):e004251. doi: 10.1136/bmjopen-2013-004251.
To compare mortality in chronic kidney disease (CKD) stages 4 and 5 (estimated glomerular filtration rate <30 mL/min/1.73 m(2)), peritoneal dialysis, haemodialysis and transplanted patients.
Population-based cohort study.
Swedish national healthcare system.
Swedish adult patients with CKD stages 4 and 5 (n=3040; mean age 66 years), peritoneal dialysis (n=725; 60 years), haemodialysis (n=1791; 62 years) and renal transplantation (n=606; 48 years) were identified in Stockholm County clinical quality registers for renal disease between 1999 and 2010. Five general population controls were matched to each patient by age, sex and index year.
CKD status (stage 4 or 5/peritoneal dialysis/haemodialysis/transplanted).
All-cause mortality was ascertained from the Swedish Causes of Death Register. Mortality HRs were estimated using Cox regression conditioned on age, sex, diabetes status, education level and index year.
During 6553 person-years, 766 patients with CKD stages 4 and 5 died (deaths/100 person-years 12, 95% CI 11 to 13) compared with 186 deaths during 1113 person-years in peritoneal dialysis (17, 95% CI 15 to 19), 924 deaths during 3680 person-years in haemodialysis (25, 95% CI 23 to 27) and 53 deaths during 2935 person-years in transplanted patients (1.8, 95% CI 1.4 to 2.4). Against matched general population controls, the mortality HR was 3.6 (95% CI 3.2 to 4.0) for CKD, 5.6 (95% CI 3.5 to 8.9) for transplanted patients, 9.2 (95% CI 6.6 to 12.7) for peritoneal dialysis and 12.6 (95% CI 10.8 to 14.6) for haemodialysis. In direct comparison versus CKD, the mortality HR was 1.7 (95% CI 1.4 to 2.1) for peritoneal dialysis, 2.6 (95% CI 2.3 to 2.9) for haemodialysis and 0.5 (95% CI 0.3 to 0.7) for transplanted patients.
We did not find support for mortality in CKD to be similar to dialysis mortality. The patients with CKD stages 4 and 5 had considerably lower mortality risk than dialysis patients, and considerably higher risk than transplanted patients and matched general population controls.
比较慢性肾脏病（CKD）4期和5期（估计肾小球滤过率<30 mL/（min·1.73 m²））患者、腹膜透析患者、血液透析患者及肾移植患者的死亡率。
基于人群的队列研究。
瑞典国家医疗保健系统。
1999年至2010年间，在斯德哥尔摩郡肾脏疾病临床质量登记处识别出瑞典成年CKD 4期和5期患者（n = 3040；平均年龄66岁）、腹膜透析患者（n = 725；60岁）、血液透析患者（n = 1791；62岁）和肾移植患者（n = 606；48岁）。按年龄、性别和索引年份为每位患者匹配5名普通人群对照。
CKD状态（4期或5期/腹膜透析/血液透析/肾移植）。
从瑞典死亡原因登记处确定全因死亡率。使用基于年龄、性别、糖尿病状态、教育水平和索引年份的Cox回归估计死亡率HR。
在6553人年期间，3040例CKD 4期和5期患者中有766例死亡（每100人年死亡12例，95%CI 11至13），而在1113人年期间，腹膜透析患者中有186例死亡（17例，95%CI 15至19），在3680人年期间，血液透析患者中有924例死亡（25例，95%CI 23至27），在2935人年期间，肾移植患者中有53例死亡（1.8例，95%CI 1.4至2.4）。与匹配的普通人群对照相比，CKD患者的死亡率HR为3.6（95%CI 3.2至4.0），肾移植患者为5.6（95%CI 3.5至8.9），腹膜透析患者为9.2（95%CI 6.6至12.7），血液透析患者为12.6（95%CI 10.8至14.6）。与CKD直接比较，腹膜透析的死亡率HR为1.7（95%CI 1.4至2.1），血液透析为2.6（95%CI 2.3至2.9），肾移植患者为0.5（95%CI 0.3至0.7）。
我们未发现支持CKD患者死亡率与透析患者死亡率相似的证据。CKD 4期和5期患者的死亡风险明显低于透析患者，但高于肾移植患者和匹配的普通人群对照。
