Magalhães Luciene P, Dos Reis Luciene M, Graciolli Fabiana G, Pereira Benedito J, de Oliveira Rodrigo B, de Souza Altay A L, Moyses Rosa M, Elias Rosilene M, Jorgetti Vanda
Nephrology Division, Medical School, University of São Paulo, São Paulo, Brazil.
Medicine Master Degree Program, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil.
PLoS One. 2017 Jan 3;12(1):e0167895. doi: 10.1371/journal.pone.0167895. eCollection 2017.
Chronic kidney disease (CKD) affects 10-15% of adult population worldwide. Incident patients on hemodialysis, mainly those on urgent-start dialysis at the emergency room, have a high mortality risk, which may reflect the absence of nephrology care. A lack of data exists regarding the influence of baseline factors on the mortality of these patients. The aim of this study was to evaluate the clinical and laboratory characteristics of this population and identify risk factors that contribute to their mortality.
We studied 424 patients who were admitted to our service between 01/2006 and 12/2012 and were followed for 1 year. We analyzed vascular access, risk factors linked to cardiovascular disease (CVD) and mineral and bone disease associated with CKD (CKD-MBD), and clinical events that occurred during the follow-up period. Factors that influenced patient survival were evaluated by Cox regression analysis.
The patient mean age was 50 ± 18 years, and 58.7% of them were male. Hypertension was the main cause of primary CKD (31.8%). Major risk factors were smoking (19.6%), dyslipidemia (48.8%), and CVD (41%). Upon admission, most patients had no vascular access for hemodialysis (89.4%). Biochemical results showed that most patients were anemic with high C-reactive protein levels, hypocalcemia, hyperphosphatemia, elevated parathyroid hormone and decreased 25-hydroxy vitamin D. At the end of one year, 60 patients died (14.1%). These patients were significantly older, had a lower percentage of arteriovenous fistula in one year, and low levels of 25-hydroxy vitamin D.
The combined evaluation of clinical and biochemical parameters and risk factors revealed that the mortality in urgent-start dialysis is associated with older age and low levels of vitamin D deficiency. A lack of a permanent hemodialysis access after one year was also a risk factor for mortality in this population.
慢性肾脏病（CKD）影响着全球10% - 15%的成年人口。新接受血液透析的患者，主要是那些在急诊室接受紧急启动透析的患者，具有较高的死亡风险，这可能反映了缺乏肾脏病学护理。关于基线因素对这些患者死亡率的影响，目前缺乏相关数据。本研究的目的是评估该人群的临床和实验室特征，并确定导致其死亡的风险因素。
我们研究了2006年1月至2012年12月期间入住我院并随访1年的424例患者。我们分析了血管通路、与心血管疾病（CVD）相关的风险因素以及与CKD相关的矿物质和骨疾病（CKD-MBD），以及随访期间发生的临床事件。通过Cox回归分析评估影响患者生存的因素。
患者的平均年龄为50±18岁，其中58.7%为男性。高血压是原发性CKD的主要原因（31.8%）。主要风险因素为吸烟（19.6%）、血脂异常（48.8%）和CVD（41%）。入院时，大多数患者没有用于血液透析的血管通路（89.4%）。生化结果显示，大多数患者贫血，C反应蛋白水平高，低钙血症，高磷血症，甲状旁腺激素升高，25-羟维生素D降低。在一年结束时，60例患者死亡（14.1%）。这些患者年龄明显较大，一年内动静脉内瘘的比例较低，且25-羟维生素D水平较低。
对临床和生化参数及风险因素的综合评估显示，紧急启动透析患者的死亡率与年龄较大和维生素D缺乏水平较低有关。一年后缺乏永久性血液透析通路也是该人群死亡的一个风险因素。
