澳大利亚和新西兰的血液透析撤机：一项两国注册研究。

Haemodialysis withdrawal in Australia and New Zealand: a binational registry study.

机构信息

Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.

Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.

出版信息

Nephrol Dial Transplant. 2020 Apr 1;35(4):669-676. doi: 10.1093/ndt/gfz160.

DOI:10.1093/ndt/gfz160

PMID:31397483

Abstract

BACKGROUND

Withdrawal from dialysis is an increasingly common cause of death in patients with end-stage kidney disease (ESKD). As most published reports of dialysis withdrawal have been outside the Oceania region, the aims of this study were to determine the frequency, temporal pattern and predictors of dialysis withdrawal in Australian and New Zealand patients receiving chronic haemodialysis.

METHODS

This study included all people with ESKD in Australia and New Zealand who commenced chronic haemodialysis between 1 January 1997 and 31 December 2016, using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Competing risk regression models were used to identify predictors of dialysis withdrawal mortality, using non-withdrawal cause of death as the competing risk event.

RESULTS

Among 40 447 people receiving chronic haemodialysis (median age 62 years, 61% male, 9% Indigenous), dialysis withdrawal mortality rates increased from 1.02 per 100 patient-years (11% of all deaths) during the period 1997-2000 to 2.20 per 100 patient-years (32% of all deaths) during 2013-16 (P < 0.001). Variables that were significantly associated with a higher likelihood of haemodialysis withdrawal were older age {≥70 years subdistribution hazard ratio [SHR] 1.77 [95% confidence interval (CI) 1.66-1.89]; reference 60-70 years}, female sex [SHR 1.14 (95% CI 1.09-1.21)], white race [Asian SHR 0.56 (95% CI 0.49-0.65), Aboriginal and Torres Strait Islander SHR 0.83 (95% CI 0.74-0.93), Pacific Islander SHR 0.47 (95% CI 0.39-0.68), reference white race], coronary artery disease [SHR 1.18 (95% CI 1.11-1.25)], cerebrovascular disease [SHR 1.15 (95% CI 1.08-1.23)], chronic lung disease [SHR 1.13 (95% CI 1.06-1.21)] and more recent era [2013-16 SHR 3.96 (95% CI 3.56-4.48); reference 1997-2000].

CONCLUSIONS

Death due to haemodialysis withdrawal has become increasingly common in Australia and New Zealand over time. Predictors of haemodialysis withdrawal include older age, female sex, white race and haemodialysis commencement in a more recent era.

摘要

背景

在终末期肾病（ESKD）患者中，停止透析是导致死亡的一个越来越常见的原因。由于大多数已发表的关于停止透析的报告都来自大洋洲以外的地区，因此本研究的目的是确定在澳大利亚和新西兰接受慢性血液透析的患者中停止透析的频率、时间模式和预测因素。

方法

本研究纳入了 1997 年 1 月 1 日至 2016 年 12 月 31 日期间在澳大利亚和新西兰开始接受慢性血液透析的所有 ESKD 患者，使用澳大利亚和新西兰透析和移植（ANZDATA）登记处的数据。使用竞争风险回归模型，将非透析死亡原因作为竞争风险事件，确定停止透析死亡率的预测因素。

结果

在 40447 名接受慢性血液透析的患者中（中位年龄 62 岁，61%为男性，9%为原住民），透析退出死亡率从 1997-2000 年期间的每 100 名患者年 1.02 例（所有死亡人数的 11%）上升至 2013-16 年期间的每 100 名患者年 2.20 例（所有死亡人数的 32%）（P<0.001）。与血液透析退出更有可能相关的变量包括年龄较大（≥70 岁亚分布风险比 [SHR] 1.77 [95%置信区间 1.66-1.89]；参考 60-70 岁）、女性（SHR 1.14 [95% CI 1.09-1.21]）、白种人（亚洲 SHR 0.56 [95% CI 0.49-0.65]，原住民和托雷斯海峡岛民 SHR 0.83 [95% CI 0.74-0.93]，太平洋岛民 SHR 0.47 [95% CI 0.39-0.68]，参考白种人）、冠状动脉疾病（SHR 1.18 [95% CI 1.11-1.25]）、脑血管疾病（SHR 1.15 [95% CI 1.08-1.23]）、慢性肺部疾病（SHR 1.13 [95% CI 1.06-1.21]）和最近的时期（2013-16 年 SHR 3.96 [95% CI 3.56-4.48]；参考 1997-2000 年）。