Division of Nephrology, University of British Columbia, Vancouver, Canada.
Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada.
Am J Transplant. 2020 Sep;20(9):2481-2490. doi: 10.1111/ajt.15917. Epub 2020 May 13.
Longer pretransplant dialysis exposure is associated with a higher risk of transplant failure. Whether patients who receive dialysis in a region with a higher rate of dialysis mortality are a higher risk for transplant failure is unknown. Adjusted state-specific hemodialysis mortality rates were determined in 3-year intervals among prevalent dialysis patients in the United States between 1995 and 2012. The effect of state- and period-specific dialysis mortality on the association of pretransplant dialysis exposure with transplant survival through December 2017 was determined using multivariable models. Dialysis mortality within states ranged from 128 deaths/1000 patient-years to 330 deaths/1000 patient-years. Each additional year of dialysis was associated with a 4% higher risk of transplant failure in states within the lowest quartile of dialysis mortality, compared with an 8% higher risk in states within the highest quartile of dialysis mortality. Patients who received pretransplant dialysis treatment in a state with a high rate of dialysis mortality are at a higher risk for transplant failure compared with patients with the same duration of pretransplant dialysis treatment in a state with a lower mortality rate. The findings may have implications for dialysis care in transplant candidates and the design of future outcome metrics.
透析前暴露时间较长与移植失败风险增加相关。在透析死亡率较高的地区接受透析的患者是否更有可能移植失败尚不清楚。在美国，1995 年至 2012 年间，在普遍接受透析的患者中，每 3 年确定一次调整后的特定州别和时期的血液透析死亡率。通过多变量模型确定了特定州和时期的透析死亡率对移植前透析暴露与移植生存之间关系的影响，直至 2017 年 12 月。州内的透析死亡率范围从每 1000 患者年 128 例死亡到每 1000 患者年 330 例死亡。与透析死亡率最低四分位的州的患者相比，透析死亡率最高四分位的州的患者每增加一年透析，移植失败的风险增加 4%；与透析死亡率较低的州的患者相比，透析死亡率较高的州的患者每增加一年透析，移植失败的风险增加 8%。与在透析死亡率较低的州接受相同透析前治疗时间的患者相比，在透析死亡率较高的州接受透析前治疗的患者移植失败的风险更高。这些发现可能对移植候选者的透析护理和未来结果指标的设计产生影响。
