Obialo Chamberlain I, Hunt William C, Bashir Khalid, Zager Phillip G
Renal Section, Department of Medicine , Morehouse School of Medicine , Atlanta, GA , USA.
Dialysis Clinic Inc. , Albuquerque, NM , USA.
Clin Kidney J. 2012 Aug;5(4):315-9. doi: 10.1093/ckj/sfs071.
The relationship of missed and shortened hemodialysis (HD) to clinical outcomes has not been well characterized in HD patients in the USA. Here we explored the frequency of missed and shortened treatments and their impact on mortality and hospitalization.
A retrospective review of data from a cohort of 15 340 HD patients treated in facilities operated by Dialysis Clinics, Inc. We compared the frequency of missed and shortened treatments by gender, race, age and treatment schedules [Mondays, Wednesdays, Fridays (MWF) versus Tuesdays, Thursdays, Saturdays (TTS)].
Of the 15 340 patients, 48% were non-Hispanic whites (NHWs), 41% African Americans (AAs), 6% Hispanics, 2% Native American (NA), 2% Asians and 1% other races. The median number of years on HD was 1.8 years and the median follow-up was 12.4 months. The odds of missing at least one treatment in a month were higher in: patients aged <55 years, odds ratio (OR) 1.33 (P<0.0001); in AAs, OR 1.51 (P < 0.0001); in NAs, OR 1.50 (P = 0.0003); and in Hispanics, OR 1.33 (P = 0.0003) compared with NHWs and in patients who dialyzed on TTS compared with MWF, OR 1.33 (P < 0.0001). Similar findings were observed for treatments shortened by at least 10 min per month. Missed and shortened treatments were most prevalent on Saturdays and were also associated with progressive increases in hospitalization and mortality.
Missed and shortened HD treatments pose a challenge to providers. Improved adherence to prescribed dialysis may decrease the morbidity and mortality.
在美国血液透析（HD）患者中，错过和缩短血液透析治疗与临床结局之间的关系尚未得到充分描述。在此，我们探讨了错过和缩短治疗的频率及其对死亡率和住院率的影响。
对在透析诊所公司运营的设施中接受治疗的15340名HD患者队列的数据进行回顾性分析。我们比较了按性别、种族、年龄和治疗时间表[周一、周三、周五（MWF）与周二、周四、周六（TTS）]划分的错过和缩短治疗的频率。
在15340名患者中，48%为非西班牙裔白人（NHW），41%为非裔美国人（AA），6%为西班牙裔，2%为美洲原住民（NA），2%为亚洲人，1%为其他种族。HD治疗的中位年数为1.8年，中位随访时间为12.4个月。以下患者每月至少错过一次治疗的几率更高：年龄<55岁的患者，比值比（OR）为1.33（P<0.0001）；AA患者，OR为1.51（P<0.0001）；NA患者，OR为1.50（P = 0.0003）；西班牙裔患者，与NHW患者相比OR为1.33（P = 0.0003），以及与MWF治疗的患者相比，TTS治疗的患者OR为1.33（P<0.0001）。每月至少缩短10分钟治疗的情况也有类似发现。错过和缩短治疗在周六最为普遍，并且还与住院率和死亡率的逐步上升相关。
错过和缩短HD治疗给医护人员带来了挑战。提高对规定透析治疗的依从性可能会降低发病率和死亡率。
