长期透析患者发生脑积水的风险增加。

Increased risk of hydrocephalus in long-term dialysis patients.

机构信息

Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan.

Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan College of Medicine, China Medical University, Taichung, Taiwan.

出版信息

Nephrol Dial Transplant. 2016 May;31(5):807-13. doi: 10.1093/ndt/gfw015. Epub 2016 Mar 8.

DOI:10.1093/ndt/gfw015

PMID:26961997

Abstract

BACKGROUND

The risk of hydrocephalus in end-stage renal disease (ESRD) patients on dialysis has not been studied in depth.

METHODS

Using Taiwan National Health Insurance claims data, we identified 29 684 incident ESRD patients from 2000 to 2010, including 10 030 peritoneal dialysis (PD) patients and 19 654 hemodialysis (HD) patients. The control cohort consisted of 118 736 people randomly selected from those without kidney disease, frequency matched with ESRD patients by age, sex and index year. We also established propensity score-matched cohorts with 10 014 PD and 10 014 HD patients. The incidence rates and hazard ratios (HRs) of hydrocephalus were calculated until the end of 2011.

RESULTS

Incidence rates of hydrocephalus were greater in HD and PD patients than in controls (8.44 and 11.0 versus 4.11 per 10 000 person-years, respectively), with an adjusted HR of 1.86 [95% confidence interval (CI) 1.43-2.41] for all ESRD patients compared with controls. A higher proportion of hydrocephalus patients underwent surgical bypass to relieve hydrocephalus in ESRD patients than controls, 40.7% (46/113) versus 24.5% (67/273), with an adjusted odds ratio of 2.11 (95% CI 1.33-3.36). Compared with controls, the adjusted HRs of communicating hydrocephalus for HD and PD patients were 1.77 (95% CI 1.22-2.55) and 2.51 (95% CI 1.61-3.89), respectively. The propensity score-matched analysis showed an HR of 0.72 (95% CI 0.42-1.23) for hydrocephalus in HD patients compared with PD patients.

CONCLUSIONS

Patients with ESRD are at an increased risk of hydrocephalus. The risk difference between HD and PD patients is not significant.

摘要

背景

在接受透析治疗的终末期肾病（ESRD）患者中，脑积水的风险尚未得到深入研究。

方法

我们利用台湾全民健康保险理赔数据，从 2000 年至 2010 年确定了 29684 例 ESRD 患者，其中包括 10030 例腹膜透析（PD）患者和 19654 例血液透析（HD）患者。对照组由从无肾脏病患者中随机抽取的 118736 人组成，按年龄、性别和指数年份与 ESRD 患者进行频数匹配。我们还建立了 10014 例 PD 和 10014 例 HD 患者的倾向评分匹配队列。直到 2011 年底，计算脑积水的发生率和风险比（HRs）。

结果

HD 和 PD 患者的脑积水发生率高于对照组（分别为 8.44 和 11.0 比 4.11/10000 人年），与对照组相比，所有 ESRD 患者的调整 HR 为 1.86（95%CI 1.43-2.41）。与对照组相比，ESRD 患者中更多的脑积水患者接受手术分流以缓解脑积水，比例分别为 40.7%（46/113）和 24.5%（67/273），调整后的比值比为 2.11（95%CI 1.33-3.36）。与对照组相比，HD 和 PD 患者交通性脑积水的调整 HR 分别为 1.77（95%CI 1.22-2.55）和 2.51（95%CI 1.61-3.89）。倾向评分匹配分析显示，与 PD 患者相比，HD 患者脑积水的 HR 为 0.72（95%CI 0.42-1.23）。