Escuela Andaluza de Salud Pública (EASP), Campus Universitario de Cartuja, Granada, Spain.
CIBER en Epidemiología y Salud Pública (CIBERESP), Granada, Spain.
PLoS One. 2019 Jul 30;14(7):e0219037. doi: 10.1371/journal.pone.0219037. eCollection 2019.
To compare the survival among patients with chronic kidney disease who had optimal starts of renal replacement therapy, dialysis or hemodialysis, with patients who had suboptimal starts.
A retrospective cohort consisting of >18 year-old patients who started renal replacement therapy, using peritoneal dialysis or hemodialysis, in any public hospital or associated center of the Andalusian Public Health System, between the 1st of January of 2006 and the 15th of March of 2017. The optimal start was defined when all the following criteria were met: a planned dialysis start, a minimum of six-month follow-up by a nephrologist, and a first dialysis method coinciding with the one registered at 90 days. The information was obtained from the registry of the Information System of the Transplant Autonomic Coordination of Andalusia.
A total of 10,692 patients were studied. 4,377 (40.9%) of these patients died. A total of 4,937 patients (46.17%) achieved optimal starts of renal replacement therapy and showed higher survival rates (HR 0.669; 95% CI 0.628-0.712) in the multivariate analysis of Cox regression model.
Patients with an optimal start of renal replacement therapy have a greater survival than those who had a non-optimal start. Therefore, the necessary measures should be encouraged to increase the optimal start of the patient in dialysis.
比较开始接受肾脏替代治疗（透析或血液透析）时达到最佳起始条件、次优起始条件的慢性肾脏病患者的生存率。
这是一项回顾性队列研究，纳入了 2006 年 1 月 1 日至 2017 年 3 月 15 日期间在安达卢西亚公共卫生系统的任何公立医院或相关中心开始接受腹膜透析或血液透析的年龄>18 岁的患者。最佳起始条件定义为符合以下所有标准：计划开始透析、由肾病医生进行至少 6 个月的随访、以及首次透析方法与 90 天内登记的方法一致。信息来自安达卢西亚器官自主协调信息系统的登记处。
共纳入 10692 例患者，其中 4377 例（40.9%）死亡。共有 4937 例（46.17%）患者达到了肾脏替代治疗的最佳起始条件，在多变量 Cox 回归模型的分析中显示出更高的生存率（HR 0.669；95%CI 0.628-0.712）。
开始接受肾脏替代治疗时达到最佳起始条件的患者比未达到最佳起始条件的患者有更好的生存机会。因此，应鼓励采取必要措施，以增加透析患者的最佳起始条件。
