Higuchi Satoshi, Nakaya Izaya, Yoshikawa Kazuhiro, Chikamatsu Yoichiro, Sada Ken-Ei, Yamamoto Suguru, Takahashi Satoko, Sasaki Hiroyo, Soma Jun
Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, Morioka, Japan.
Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Kidney Int Rep. 2017 Feb 10;2(4):594-602. doi: 10.1016/j.ekir.2017.01.015. eCollection 2017 Jul.
Late referral to a nephrologist, the type of vascular access, nutritional status, and the estimated glomerular filtration rate (eGFR) at the start of hemodialysis (HD) have been reported as independent risk factors of survival for patients who begin HD. The aim of this study was to clarify the influence of the HD-free interval from the time of an eGFR of 10 ml/min per 1.73 m (I) on patient outcome.
We enrolled 124 patients aged older than 20 years who had HD initiated in a general hospital. The predictive factor was the HD-free I. The primary outcome was the relationship of the HD-free interval on death or the onset of a cardiovascular event. Survival analysis was performed using the Cox regression model.
The median I was 159 days (range: 2-1687 days). The median eGFR at the initiation of HD was 5.48 ml/min per 1.73 m. Sixty-seven of 124 patients (54.0%) reached the primary outcome. Of these, 29 died and 38 experienced a cardiovascular event. In univariate analysis, older age, a history of cardiovascular disease, nephrologic care for <6 months, higher modified Charlson comorbidity index score, poor performance status, temporary catheter, edema, diabetic retinopathy, and nonuse of erythropoiesis-stimulating agent were statistically related to the primary outcome. The unadjusted hazard ratio per log-transformed I was 0.393 (95% confidence interval [CI]; 0.244-0.635; < 0.001) and the hazard ratio adjusted for confounding factors was 0.507 (95% CI: 0.267-0.956; = 0.036).
A longer HD-free I was associated with a lower risk of death or a cardiovascular event. The interval could be considered an independent prognostic factor for outcomes in patients on HD.
据报道，肾病科医生的转诊延迟、血管通路类型、营养状况以及血液透析（HD）开始时的估计肾小球滤过率（eGFR）是开始进行HD治疗患者生存的独立危险因素。本研究的目的是阐明从eGFR为每分钟10 ml/1.73 m²（I期）开始至开始HD治疗的无HD间期对患者预后的影响。
我们纳入了124例年龄大于20岁且在综合医院开始进行HD治疗的患者。预测因素为无HD间期（I期）。主要结局是无HD间期与死亡或心血管事件发生之间的关系。使用Cox回归模型进行生存分析。
中位I期为159天（范围：2 - 1687天）。HD开始时的中位eGFR为每分钟5.48 ml/1.73 m²。124例患者中有67例（54.0%）达到主要结局。其中，29例死亡，38例发生心血管事件。在单因素分析中，年龄较大、有心血管疾病史、接受肾病治疗时间<6个月、改良Charlson合并症指数评分较高、身体状况较差、使用临时导管、水肿、糖尿病视网膜病变以及未使用促红细胞生成素与主要结局在统计学上相关。每单位对数转换后的I期的未调整风险比为0.393（95%置信区间[CI]：0.244 - 0.635；P<0.001），经混杂因素调整后的风险比为0.507（95%CI：0.267 - 0.956；P = 0.036）。
较长的无HD间期与较低的死亡或心血管事件风险相关。该间期可被视为HD患者预后不良的独立预测因素。
