Soma Osamu, Hatakeyama Shingo, Matsumoto Teppei, Tanaka Toshikazu, Tanaka Yoshimi, Hosogoe Shogo, Kodama Hirotake, Horiguchi Hirotaka, Kubota Yuka, Kido Koichi, Momota Masaki, Anan Go, Narita Ikuyo, Kitahara Ryuji, Saitoh Hisao, Suzuki Tadashi, Ohyama Chikara
Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan.
Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
Clin Exp Nephrol. 2018 Jun;22(3):668-676. doi: 10.1007/s10157-017-1495-5. Epub 2017 Oct 25.
The impact of nail abnormalities on prognosis in hemodialysis patients is unknown. This study investigated whether toenail opacity as a readout of nail abnormalities predicted prognosis in hemodialysis patients.
In this observational study, 494 eligible hemodialysis patients who received hemodialysis at Oyokyo Kidney Research Institute between September 2010 and December 2015 were included. The presence of nail abnormalities was objectively evaluated by big toenail opacity ratio measurement. Primary endpoint was overall survival, and secondary endpoints were lower limb amputation and determination of risk factors for poor prognosis among patient demographics, comorbidities, blood tests, and big toenail opacity. Overall survival and lower limb survival were evaluated using the Kaplan-Meier method with log-rank test. Multivariate Cox regression analyses assessed predictors for poor prognosis.
Big toenail opacity was found in 259 (52%) patients. Patients with big toenail opacity were significantly older, had shorter duration of dialysis, higher prevalence rates of diabetes mellitus (DM), cardiovascular disease (CVD), and higher mortality rates than those without opacity. Presence of big toenail opacity predicted poor prognosis for both overall and lower limb survival. Multivariate Cox regression analyses revealed serum albumin, the presence of DM and big toenail opacity were independent risk factors for both poor overall and lower limb survivals.
The prevalence of big toenail opacity was high in hemodialysis patients. Despite the short observation period, our findings indicated that big toenail opacity had significant predictive power for poor overall and lower limb survival.
指甲异常对血液透析患者预后的影响尚不清楚。本研究调查了作为指甲异常指标的趾甲浑浊是否可预测血液透析患者的预后。
在这项观察性研究中，纳入了2010年9月至2015年12月期间在Oyokyo肾脏研究所接受血液透析的494例符合条件的血液透析患者。通过测量大脚趾趾甲浑浊率客观评估指甲异常的存在情况。主要终点是总生存期，次要终点是下肢截肢以及在患者人口统计学、合并症、血液检查和大脚趾趾甲浑浊情况中确定预后不良的危险因素。使用Kaplan-Meier方法和对数秩检验评估总生存期和下肢生存期。多变量Cox回归分析评估预后不良的预测因素。
259例（52%）患者存在大脚趾趾甲浑浊。与无趾甲浑浊的患者相比，有大脚趾趾甲浑浊的患者年龄显著更大，透析时间更短，糖尿病（DM）、心血管疾病（CVD）患病率更高，死亡率也更高。大脚趾趾甲浑浊的存在预示着总体生存期和下肢生存期预后不良。多变量Cox回归分析显示，血清白蛋白、DM的存在以及大脚趾趾甲浑浊是总体生存期和下肢生存期不良的独立危险因素。
血液透析患者中大脚趾趾甲浑浊的患病率很高。尽管观察期较短，但我们的研究结果表明，大脚趾趾甲浑浊对总体生存期和下肢生存期不良具有显著的预测能力。
