2005 - 2007年宾夕法尼亚州急性血液透析后的生存率：一项回顾性队列研究。

Survival after acute hemodialysis in Pennsylvania, 2005-2007: a retrospective cohort study.

作者信息

Ramer Sarah J, Cohen Elan D, Chang Chung-Chou H, Unruh Mark L, Barnato Amber E

机构信息

Rutgers New Jersey Medical School, Newark, New Jersey, United States of America.

Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.

出版信息

PLoS One. 2014 Aug 20;9(8):e105083. doi: 10.1371/journal.pone.0105083. eCollection 2014.

DOI:10.1371/journal.pone.0105083

PMID:25141028

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4139312/

Abstract

BACKGROUND

Little is known about acute hemodialysis in the US. Here we describe predictors of receipt of acute hemodialysis in one state and estimate the marginal impact of acute hemodialysis on survival after accounting for confounding due to illness severity.

MATERIALS AND METHODS

This is a retrospective cohort study of acute-care hospitalizations in Pennsylvania from October 2005 to December 2007 using data from the Pennsylvania Health Care Cost Containment Council. Exposure variable is acute hemodialysis; dependent variable is survival following acute hemodialysis. We used multivariable logistic regression to determine propensity to receive acute hemodialysis and then, for a Cox proportional hazards model, matched acute hemodialysis and non-acute hemodialysis patients 1∶5 on this propensity.

RESULTS

In 2,131,248 admissions of adults without end-stage renal disease, there were 6,657 instances of acute hemodialysis. In analyses adjusted for predicted probability of death upon admission plus other covariates and stratified on age, being male, black, and insured were independent predictors of receipt of acute hemodialysis. One-year post-admission mortality was 43% for those receiving acute hemodialysis, compared to 13% among those not receiving acute hemodialysis. After matching on propensity to receive acute hemodialysis and adjusting for predicted probability of death upon admission, patients who received acute hemodialysis had a higher risk of death than patients who did not over at least 1 year of follow-up (hazard ratio 1·82, 95% confidence interval 1·68-1·97).

CONCLUSIONS

In a populous US state, receipt of acute hemodialysis varied by age, sex, race, and insurance status even after adjustment for illness severity. In a comparison of patients with similar propensity to receive acute hemodialysis, those who did receive it were less likely to survive than those who did not. These findings raise questions about reasons for lack of benefit.

摘要

背景

在美国，关于急性血液透析的了解甚少。在此，我们描述了一个州接受急性血液透析的预测因素，并在考虑疾病严重程度导致的混杂因素后，估计急性血液透析对生存的边际影响。

材料与方法

这是一项对2005年10月至2007年12月宾夕法尼亚州急性护理住院患者的回顾性队列研究，使用宾夕法尼亚医疗保健成本控制委员会的数据。暴露变量为急性血液透析；因变量为急性血液透析后的生存情况。我们使用多变量逻辑回归来确定接受急性血液透析的倾向，然后在Cox比例风险模型中，根据这种倾向以1∶5的比例匹配急性血液透析患者和非急性血液透析患者。

结果

在2131248例无终末期肾病的成人住院病例中，有6657例急性血液透析病例。在对入院时预测死亡概率及其他协变量进行调整并按年龄分层的分析中，男性、黑人及参保是接受急性血液透析的独立预测因素。接受急性血液透析的患者入院后1年死亡率为43%，而未接受急性血液透析的患者为13%。在根据接受急性血液透析的倾向进行匹配并对入院时预测死亡概率进行调整后，接受急性血液透析的患者在至少1年的随访期内死亡风险高于未接受急性血液透析的患者（风险比1.82，95%置信区间1.68 - 1.97）。