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血液透析滤过与血液透析对终末期肾病患者生存的影响：法国肾脏流行病学和信息网络（REIN）登记研究。

Hemodiafiltration Versus Hemodialysis and Survival in Patients With ESRD: The French Renal Epidemiology and Information Network (REIN) Registry.

机构信息

Department of Nephrology, Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Paris, France; INSERM UMRS-1018, CESP Team 5 (Renal and Cardiovascular Epidemiology), Villejuif, France; Paris Sud University, Kremlin-Bicêtre, France; Versailles Saint-Quentin University, Versailles, France.

INSERM UMRS-1018, CESP Team 5 (Renal and Cardiovascular Epidemiology), Villejuif, France.

出版信息

Am J Kidney Dis. 2016 Aug;68(2):247-255. doi: 10.1053/j.ajkd.2015.11.016. Epub 2015 Dec 25.

DOI:10.1053/j.ajkd.2015.11.016

PMID:26724836

Abstract

BACKGROUND

Recent randomized trials report that mortality is lower with high-convection-volume hemodiafiltration (HDF) than with hemodialysis (HD).

STUDY DESIGN

We used data from the French national Renal Epidemiology and Information Network (REIN) registry to investigate trends in HDF use and its relationship with mortality in the total population of incident dialysis patients.

SETTING & PARTICIPANTS: The study included those who initiated HD therapy from January 1, 2008, through December 31, 2011, and were dialyzed for more than 3 months; follow-up extended to the end of 2012.

FACTOR

HDF use at the patient and facility level.

OUTCOMES

All-cause and cardiovascular mortality, using Cox models to estimate HRs of HDF as time-dependent covariate at the patient level, with age as time scale and fully adjusted for comorbid conditions and laboratory data at baseline, catheter use, and facility type as time-dependent covariates. Analyses completed by Cox models for HRs of the facility-level exposure to HDF updated yearly.

RESULTS

Of 28,407 HD patients, 5,526 used HDF for a median of 1.2 (IQR, 0.9-1.9) years; 2,254 of them used HDF exclusively. HRs for all-cause and cardiovascular mortality associated with HDF use were 0.84 (95% CI, 0.77-0.91) and 0.73 (95% CI, 0.61-0.88), respectively. In patients treated exclusively with HDF, these HRs were 0.77 (95% CI, 0.67-0.87) and 0.66 (95% CI, 0.50-0.86). At the facility level, increasing the percentage of patients using HDF from 0% to 100% was associated with HRs for all-cause and cardiovascular mortality of 0.87 (95% CI, 0.77-0.99) and 0.72 (95% CI, 0.54-0.96), respectively.

LIMITATIONS

Observational study.

CONCLUSIONS

Whether analyzed as a patient- or facility-level predictor, HDF treatment was associated with better survival.

摘要

背景

最近的随机试验报告称，高容量对流血液透析（HDF）的死亡率低于血液透析（HD）。

研究设计

我们使用法国国家肾脏流行病学和信息网络（REIN）登记处的数据，研究了 HDF 使用的趋势及其与所有新接受透析治疗的患者人群死亡率之间的关系。

设置和参与者

本研究包括 2008 年 1 月 1 日至 2011 年 12 月 31 日期间开始接受 HD 治疗且透析时间超过 3 个月的患者；随访时间延长至 2012 年底。

因素

患者和医疗机构层面的 HDF 使用情况。

结果

采用 Cox 模型估计患者水平上 HDF 作为时间依赖性协变量的全因死亡率和心血管死亡率的 HR，年龄为时间尺度，并完全调整了基线时的合并症和实验室数据、导管使用和设施类型作为时间依赖性协变量。每年通过 Cox 模型分析设施层面 HDF 暴露的 HR。

在 28407 名 HD 患者中，5526 名患者接受 HDF 治疗，中位数为 1.2（IQR，0.9-1.9）年；其中 2254 名患者仅接受 HDF 治疗。与 HDF 使用相关的全因死亡率和心血管死亡率的 HR 分别为 0.84（95%CI，0.77-0.91）和 0.73（95%CI，0.61-0.88）。在仅接受 HDF 治疗的患者中，这些 HR 分别为 0.77（95%CI，0.67-0.87）和 0.66（95%CI，0.50-0.86）。在医疗机构层面，将使用 HDF 的患者比例从 0%增加到 100%，与全因死亡率和心血管死亡率的 HR 分别为 0.87（95%CI，0.77-0.99）和 0.72（95%CI，0.54-0.96）相关。