Raikou V D, Kyriaki D
1st Department of Medicine-Propaedaetic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece, Greece.
Department of Nuclear Medicine, General Hospital "LAΪKO", Athens, Greece.
Indian J Nephrol. 2018 Mar-Apr;28(2):105-112. doi: 10.4103/ijn.IJN_232_16.
Mortality is substantially elevated in patients on chronic kidney disease in comparison to general population. In this study, we observed the mortality rate in relation to risk factors including low serum bicarbonate level, coronary artery disease (CAD), and dialysis modality in patients on dialysis during a median follow-up time of 60 months. We studied 96 dialysis patients, 62 males and 34 females, on mean age 62.1 ± 14.27 years old. The treatment modalities which were applied were predilution hemodiafiltration (HDF, = 76), and peritoneal dialysis (PD, = 20). We performed Kaplan-Meier curves and a Cox-regression analysis to investigate significant risk factors for mortality including hypertension, diabetes mellitus, smoking, bone disease defined by intact-parathormone, serum albumin, serum bicarbonate levels < or >22 mEq/L, dialysis modality, and the existence of CAD. Cox-regression analysis revealed a significant impact of serum bicarbonate levels <22 mEq/L on mortality in combination to dialysis modality and CAD. The prevalence of CAD on mortality was found significant (log-rank = 5.507, = 0.02). Furthermore, the impact of dialysis modality on mortality was shown significant (log rank = 22.4, = 0.001), noting that during the first 28-30 months from the treatment initiation, the survival was better for PD; but then, the mortality was significantly increased comparatively to HDF. Uncorrected metabolic acidosis and CAD were shown as independent significant predictors for mortality in patients on renal replacement therapy. PD may provide worse survival after 2-2.5 years of treatment initiation than HDF.
与普通人群相比，慢性肾脏病患者的死亡率显著升高。在本研究中，我们观察了在中位随访时间60个月期间，透析患者的死亡率与包括低血清碳酸氢盐水平、冠状动脉疾病（CAD）和透析方式等危险因素之间的关系。我们研究了96例透析患者，其中男性62例，女性34例，平均年龄为62.1±14.27岁。所应用的治疗方式为前稀释血液透析滤过（HDF，n = 76）和腹膜透析（PD，n = 20）。我们进行了Kaplan-Meier曲线分析和Cox回归分析，以研究死亡率的显著危险因素，包括高血压、糖尿病、吸烟、由完整甲状旁腺激素定义的骨病、血清白蛋白、血清碳酸氢盐水平＜或＞22 mEq/L、透析方式以及CAD的存在情况。Cox回归分析显示，血清碳酸氢盐水平＜22 mEq/L与透析方式和CAD共同对死亡率有显著影响。发现CAD对死亡率的影响具有显著性（对数秩 = 5.507，P = 0.02）。此外，透析方式对死亡率的影响也具有显著性（对数秩 = 22.4，P = 0.001），注意到在治疗开始后的前28 - 30个月，PD患者的生存率较好；但随后，与HDF相比，死亡率显著增加。未校正的代谢性酸中毒和CAD被证明是肾替代治疗患者死亡率的独立显著预测因素。开始治疗2 - 2.5年后，PD的生存率可能比HDF更差。
