Chen Yung-Ming, Li Wen-Yi, Wu Vin-Cent, Wang Yi-Cheng, Hwang Shang-Jyh, Lin Shih-Hwa, Wu Kwan-Dun
Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan; Renal Division, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan.
PLoS One. 2015 Apr 9;10(4):e0123386. doi: 10.1371/journal.pone.0123386. eCollection 2015.
Discontinuation of acute, unplanned dialysis is always an important therapeutic goal in dialysis-requiring patients with existing chronic kidney disease. Only a limited proportion of patients could be weaned off dialysis and remained dialysis-free. Here we performed a multicenter, observational study to investigate factors associated with successful weaning from acute dialysis, and to explore the potential impact of weaning itself on outcomes of patients with chronic kidney disease following urgent-start dialysis. We recruited 440 chronic kidney disease patients with a baseline estimated glomerular filtration rate <45 ml/min per 1/73 m2, and used propensity score-adjusted Cox regression analysis to measure the effect of weaning from acute dialysis on death during the index hospitalization and death or readmission after discharge. Over 2 years, 64 of 421 (15.2%) patients who survived >1 month died, and 36 (8.6%) were removed from dialysis, with 26 (6.2%) remaining alive and dialysis-free. Logistic regression analysis found that age ≧ 65 years, ischemic acute tubular necrosis, nephrotoxic exposure, urinary obstruction, and higher predialysis estimated glomerular filtration rate and serum hemoglobin were predictors of weaning off dialysis. After adjustment for propensity scores for dialysis weaning, Cox proportional hazards models showed successful weaning from dialysis (adjusted hazard ratio 0.06; 95% confidence interval 0.01 to 0.35), along with a history of hypertension and serum albumin, were independent protectors for early death. Conversely, a history of stroke, peripheral arterial disease and cancer predicted the occurrence of early mortality. In conclusion, this prospective cohort study shows that compared to patients with chronic kidney disease who became end-stage renal disease after acute dialysis, patients who could be weaned off acute dialytic therapy were associated with reduced risk of premature death over a 2-year observation period.
对于患有慢性肾脏病且需要透析的患者而言，停止急性非计划性透析始终是一项重要的治疗目标。仅有一小部分患者能够停用透析并保持无需透析状态。在此，我们开展了一项多中心观察性研究，以探究与急性透析成功撤机相关的因素，并探讨撤机本身对紧急开始透析的慢性肾脏病患者预后的潜在影响。我们招募了440例基线估计肾小球滤过率<45 ml/min per 1/73 m²的慢性肾脏病患者，并使用倾向评分调整后的Cox回归分析来衡量急性透析撤机对指数住院期间死亡以及出院后死亡或再入院的影响。在2年多的时间里，421例存活超过1个月的患者中有64例（15.2%）死亡，36例（8.6%）停止透析，其中26例（6.2%）存活且无需透析。逻辑回归分析发现，年龄≥65岁、缺血性急性肾小管坏死、肾毒性暴露、尿路梗阻以及透析前较高的估计肾小球滤过率和血清血红蛋白是透析撤机的预测因素。在对透析撤机的倾向评分进行调整后，Cox比例风险模型显示，透析成功撤机（调整后风险比0.06；95%置信区间0.01至0.35）以及高血压病史和血清白蛋白是早期死亡的独立保护因素。相反，中风、外周动脉疾病和癌症病史预示着早期死亡的发生。总之，这项前瞻性队列研究表明，与急性透析后进入终末期肾病的慢性肾脏病患者相比，能够停用急性透析治疗的患者在2年观察期内过早死亡风险降低。
