Rydell Helena, Clyne Naomi, Segelmark Mårten
Department of Nephrology Skx00E5;ne University Hospital and Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.
Kidney Blood Press Res. 2016;41(4):392-401. doi: 10.1159/000443441. Epub 2016 Jun 27.
BACKGROUND/AIMS: Survival for dialysis patients is poor. Earlier studies have shown better survival in home-hemodialysis (HHD). The aims of this study are to compare survival for matched patients with HHD and institutional hemodialysis (IHD) and to elucidate the effect on factors related to survival such as hyperphosphatemia, fluid overload and anemia.
In this retrospective, observational study, incident patients starting HHD and IHD were matched according to sex, age, comorbidity and date of start. Survival analysis was performed both as "intention to treat" including renal transplantation and "on treatment" with censoring at the date of transplantation. Dialysis doses, laboratory parameters and prescriptions of medications were compared.
After matching, 41 pairs of patients, with HHD and IHD, were included. Survival among HHD patients was longer compared with IHD, median survival being 17.3 and 13.0 years (p=0.016), respectively. The "on treatment" analysis, also favoured HHD (p=0.015). HHD patients had lower phosphate, 1.5 mmol/L compared with 2.1 mmol/L (p<0.001) and no antihypertensives and diuretics compared with 2 for IHD patients at 6 (p=0.001) and 18 months (p=0.014). There were no differences in hemoglobin or albumin.
HHD shows better survival compared with IHD, also after controlling for patient selection. This could be caused by better phosphate and/or fluid balance associated with higher dialysis doses.
背景/目的：透析患者的生存率较低。早期研究表明，家庭血液透析（HHD）患者的生存率更高。本研究的目的是比较匹配的HHD患者和机构血液透析（IHD）患者的生存率，并阐明高磷血症、液体超负荷和贫血等与生存相关因素的影响。
在这项回顾性观察研究中，根据性别、年龄、合并症和开始日期对开始HHD和IHD的新发病例患者进行匹配。生存分析既作为“意向性治疗”（包括肾移植）进行，也作为“治疗中”分析，在移植日期进行删失。比较透析剂量、实验室参数和药物处方。
匹配后，纳入了41对HHD和IHD患者。HHD患者的生存期比IHD患者长，中位生存期分别为17.3年和13.0年（p=0.016）。“治疗中”分析也支持HHD（p=0.015）。HHD患者的磷酸盐水平较低，为1.5 mmol/L，而IHD患者为2.1 mmol/L（p<0.001），且HHD患者在6个月（p=0.001）和18个月（p=0.014）时使用的抗高血压药和利尿剂数量比IHD患者少，IHD患者分别为2种。血红蛋白或白蛋白水平无差异。
与IHD相比，即使在控制患者选择因素后，HHD的生存率仍更高。这可能是由于更高的透析剂量带来更好的磷酸盐和/或液体平衡所致。
