Chang Kyung Yoon, Kim Su-Hyun, Kim Young Ok, Jin Dong Chan, Song Ho Chul, Choi Euy Jin, Kim Yong-Lim, Kim Yon-Su, Kang Shin-Wook, Kim Nam-Ho, Yang Chul Woo, Kim Yong Kyun
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
Korean J Intern Med. 2016 Nov;31(6):1131-1139. doi: 10.3904/kjim.2015.111. Epub 2016 Feb 22.
BACKGROUND/AIMS: Inadequacy of dialysis is associated with morbidity and mortality in chronic hemodialysis (HD) patients. Blood flow rate (BFR) during HD is one of the important determinants of increasing dialysis dose. However, the optimal BFR is unclear. In this study, we investigated the impact of the BFR on all-cause mortality in chronic HD patients.
Prevalent HD patients were selected from Clinical Research Center registry for end-stage renal disease cohort in Korea. We categorized patients into two groups by BFR < 250 and ≥ 250 mL/min according to the median value of BFR 250 mL/min in this study. The primary outcome was all-cause mortality.
A total of 1,129 prevalent HD patients were included. The number of patients in the BFR < 250 mL/min was 271 (24%) and in the BFR ≥ 250 mL/min was 858 (76%). The median follow-up period was 30 months. Kaplan-Meier analysis showed that the mortality rate was significantly higher in patients with BFR < 250 mL/min than those with BFR ≥ 250 mL/min ( = 0.042, log-rank). In the multivariate Cox regression analyses, patients with BFR < 250 mL/min had higher all-cause mortality than those with BFR ≥ 250 mL/min (hazard ratio, 1.66; 95% confidence interval, 1.00 to 2.73; = 0.048).
Our data showed that BFR < 250 mL/min during HD was associated with higher all-cause mortality in chronic HD patients.
背景/目的：透析不充分与慢性血液透析（HD）患者的发病率和死亡率相关。HD期间的血流量（BFR）是增加透析剂量的重要决定因素之一。然而，最佳BFR尚不清楚。在本研究中，我们调查了BFR对慢性HD患者全因死亡率的影响。
从韩国临床研究中心的终末期肾病队列登记处选取HD患者。根据本研究中BFR 250 mL/min的中位数，将患者分为BFR < 250 mL/min和≥ 250 mL/min两组。主要结局是全因死亡率。
共纳入1129例HD患者。BFR < 250 mL/min的患者有271例（24%），BFR≥250 mL/min的患者有858例（76%）。中位随访期为30个月。Kaplan-Meier分析显示，BFR < 250 mL/min的患者死亡率显著高于BFR≥250 mL/min的患者（P = 0.042，对数秩检验）。在多因素Cox回归分析中，BFR < 250 mL/min的患者全因死亡率高于BFR≥250 mL/min的患者（风险比，1.66；95%置信区间，1.00至2.73；P = 0.048）。
我们的数据表明，HD期间BFR < 250 mL/min与慢性HD患者较高的全因死亡率相关。
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