Tsai Wan-Chuan, Chen Hung-Yuan, Lin Chi-Lin, Huang Shu-Chen, Hsu Shih-Ping, Pai Mei-Fen, Peng Yu-Sen, Chiu Yen-Ling
Division of Nephrology, Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Ther Apher Dial. 2015 Oct;19(5):486-90. doi: 10.1111/1744-9987.12304. Epub 2015 May 5.
Our group has previously reported that excessive vascular access bleeding during dialysis treatment in stable hemodialysis (HD) patients was associated with anemia and may indicate poorer health. The association between excessive blood loss from access cannulation site and clinical outcomes was unknown. We hypothesized that excessive access bleeding may have an impact on all-cause and cardiovascular (CV) mortality in this population. We prospectively conducted an observational, longitudinal study of 360 HD patients. Excessive access bleeding was defined as at least an occurrence of blood loss greater than 4 mL per HD session during a study period of one month. During a median follow-up of 83 months, all-cause mortality and CV mortality were registered. Outcomes were analyzed by Kaplan-Meier and Cox proportional hazards regression analyses. A total of 118 (32.8%) participants died and 54 of these were from CV death. Using a multivariate Cox proportional hazards regression, access bleeding was found to be an independent predictor of all-cause mortality (HR 1.67, 95% CI 0.96-2.91, P = 0.070) but not for CV death (HR 1.53, 95% CI 0.88-2.68, P = 0.135). Our study identified that excessive access cannulation site bleeding could be a novel marker for increased risk of death in HD patients.
我们的研究小组之前曾报告，稳定的血液透析（HD）患者在透析治疗期间血管通路过度出血与贫血有关，可能预示健康状况较差。血管通路插管部位失血过多与临床结局之间的关联尚不清楚。我们推测，过度的血管通路出血可能会影响该人群的全因死亡率和心血管（CV）死亡率。我们对360例HD患者进行了一项前瞻性观察性纵向研究。过度的血管通路出血定义为在为期一个月的研究期间，每次HD治疗至少发生一次失血量大于4毫升的情况。在中位随访83个月期间，记录了全因死亡率和CV死亡率。通过Kaplan-Meier和Cox比例风险回归分析对结局进行分析。共有118名（32.8%）参与者死亡，其中54例死于CV死亡。使用多变量Cox比例风险回归分析，发现血管通路出血是全因死亡率的独立预测因素（HR 1.67，95% CI 0.96-2.91，P = 0.070），但不是CV死亡的独立预测因素（HR 1.53，95% CI 0.88-2.68，P = 0.135）。我们的研究发现，血管通路插管部位过度出血可能是HD患者死亡风险增加的一个新标志。
