Zhao Xinju, Wang Mei, Zuo Li
a Department of Nephrology , Peking University People's Hospital , Beijing , China.
Ren Fail. 2017 Nov;39(1):526-532. doi: 10.1080/0886022X.2017.1337583.
Early mortality risk of maintenance hemodialysis (MHD) patients varies by country and ethnicity. Here, early mortality in incident Chinese HD patients were studied.
Data from 1 January 2007 to 31 December 2013 were pulled from Beijing dialysis registry system. All included patients were followed to the end of 2013. This time period of dialysis was divided into six intervals (≤120, 121-365 days; 1-2, 2-3, 3-4, ≥5 years). Patients' demographics, primary cause of end-stage renal disease (ESRD), date of first HD, date of death, cause for death, date and cause of censoring were extracted from the registry database. All-cause mortality (per 100 patient-years) was calculated for each period stratified by sex, age and cause of ESRD. Monthly mortality rates were also calculated.
A total of 11,955 patients were included, 6738 were males and 5217 were females. The mean age at dialysis initiation was 57.7 ± 16.1 years. The median follow-up time was 19.8 months. There were total 2555 deaths. The overall mortality rate was 8.2 per 100 patient-years. Mortality rates were 18.7, 7.5, 6.9, 6.9, 6.5 and 6.2 in each period. The first 2 months mortality rates were 41.9 and 16.6 per 100 patient-years. Higher mortality was observed in patients who were older, female, diabetic and hypertensive.
The most critical period was the first 2 months of dialysis initiation. Patients who were older, female, diabetic and hypertensive had higher risk of early mortality. Our analysis highlighted that the transitional period from sever CKD stages to dialysis initiation, when optimal supportive care should be adopted, was crucial for patients' survival.
维持性血液透析（MHD）患者的早期死亡风险因国家和种族而异。在此，对中国新进入血液透析患者的早期死亡情况进行了研究。
从北京透析登记系统提取2007年1月1日至2013年12月31日的数据。所有纳入患者随访至2013年底。将这段透析时间分为六个时间段（≤120天、121 - 365天；1 - 2年、2 - 3年、3 - 4年、≥5年）。从登记数据库中提取患者的人口统计学信息、终末期肾病（ESRD）的主要病因、首次血液透析日期、死亡日期、死亡原因、审查日期和审查原因。按性别、年龄和ESRD病因对每个时间段计算全因死亡率（每100患者年）。还计算了每月死亡率。
共纳入11955例患者，其中男性6738例，女性5217例。开始透析时的平均年龄为57.7±16.1岁。中位随访时间为19.8个月。共有2555例死亡。总死亡率为每100患者年8.2例。各时间段的死亡率分别为18.7、7.5、6.9、6.9、6.5和6.2。前2个月的死亡率分别为每100患者年41.9例和16.6例。年龄较大、女性、糖尿病和高血压患者的死亡率较高。
最关键时期是开始透析的前2个月。年龄较大、女性、糖尿病和高血压患者的早期死亡风险较高。我们的分析强调，从重度慢性肾脏病阶段到开始透析的过渡期，应采用最佳支持性护理，这对患者的生存至关重要。
