澳大利亚和新西兰透析人群中透析方式与死亡率风险的时间变化。
Temporal Changes in Mortality Risk by Dialysis Modality in the Australian and New Zealand Dialysis Population.
机构信息
Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Renal Medicine, Counties Manukau, Health, Auckland, New Zealand; Baxter Healthcare (Asia Pacific), Shanghai, People's Republic of China.
Department of Nephrology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia; Department of Medicine, Monash University, Clayton, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia; Department of Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), The Royal Adelaide Hospital, Adelaide, South Australia, Australia.
出版信息
Am J Kidney Dis. 2015 Sep;66(3):489-98. doi: 10.1053/j.ajkd.2015.03.014. Epub 2015 May 6.
BACKGROUND
In most studies, home dialysis associates with greater survival than facility hemodialysis (HD). However, the relationship between mortality risk and modality can vary by era. We describe and compare changes in survival with facility HD, peritoneal dialysis, and home HD over a 15-year period using data from The Australia and New Zealand Dialysis and Transplant Registry (ANZDATA).
STUDY DESIGN
An observational inception cohort study, using Cox proportional hazards and competing-risks regression.
SETTING & PARTICIPANTS: All adult patients initiating renal replacement therapy in Australia and New Zealand since March 31, 1998, followed up to December 31, 2012.
PREDICTOR
Era at dialysis inception (1998-2002, 2003-2007, and 2008-2012). We adjusted for time-varying dialysis modality and comorbid conditions, demographics, initial state/country of treatment, late referral for nephrology care, primary kidney disease, and kidney function at dialysis inception.
OUTCOMES
Patient mortality.
RESULTS
Survival on dialysis therapy has improved despite increasing patient comorbid conditions. Compared to 1998 to 2002, there has been a 21% reduction in mortality for those on facility HD therapy, a 27% reduction for those on peritoneal dialysis therapy, and a 49% reduction for those on home HD therapy.
LIMITATIONS
Potential for residual confounding from limited collection of comorbid conditions; analyses lack data for blood pressure, fluid volume status, socioeconomics, medication, and biochemical parameters.
CONCLUSIONS
Our study indicates that outcomes on dialysis therapy are improving with time and that this improvement is most marked with home dialysis modalities, especially home HD. This might be the result of better dialysis care (eg, improving predialysis care and more appropriate selection of patients for home dialysis). Other contributing factors are possible, such as improvements in general care of patient comorbid conditions and improvements in dialysis technology, although further research is needed to clarify these issues.
背景
在大多数研究中，家庭透析与更高的生存率相关，优于机构血液透析（HD）。然而，死亡率风险与透析方式的关系可能因时代而异。我们使用澳大利亚和新西兰透析和移植登记处（ANZDATA）的数据，描述并比较了在 15 年期间，机构 HD、腹膜透析和家庭 HD 与死亡率的变化关系。
研究设计
一项观察性起始队列研究，采用 Cox 比例风险和竞争风险回归分析。
研究场所和参与者
1998 年 3 月 31 日起在澳大利亚和新西兰开始接受肾脏替代治疗的所有成年患者，随访至 2012 年 12 月 31 日。
预测因素
透析起始时的时代（1998-2002 年、2003-2007 年和 2008-2012 年）。我们根据时间变化的透析方式和合并症、人口统计学、初始治疗的国家/地区、肾脏病治疗的晚期转诊、原发肾脏疾病以及透析起始时的肾功能进行了调整。
结局
患者死亡率。
结果
尽管患者合并症不断增加，但透析治疗的生存率仍有所提高。与 1998 年至 2002 年相比，接受机构 HD 治疗的患者死亡率降低了 21%，接受腹膜透析治疗的患者死亡率降低了 27%，接受家庭 HD 治疗的患者死亡率降低了 49%。
局限性
由于合并症的收集有限，可能存在残余混杂因素；分析缺乏血压、液体量状态、社会经济学、药物和生化参数的数据。
结论
我们的研究表明，随着时间的推移，透析治疗的结果正在改善，家庭透析方式的改善最为显著，尤其是家庭 HD。这可能是由于更好的透析护理（例如，改善透析前护理和更适当地选择患者进行家庭透析）所致。其他促成因素是可能的，例如患者合并症的一般护理改善和透析技术的改进，尽管需要进一步研究来澄清这些问题。
Zotero 插件