Department of Urology, Daiyukai Daiichi Hospital, 1-6-12 Hagoromo, Ichinomiya, Aichi, 491-0025, Japan.
Division of Nephrology, Renal Replacement Therapy, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 166-8550, Japan.
Clin Exp Nephrol. 2020 Dec;24(12):1154-1161. doi: 10.1007/s10157-020-01931-7. Epub 2020 Aug 7.
Outcomes of patients with end-stage renal disease at urgent dialysis initiation are varied, but evidence of their long-term prognosis is limited. We aimed to characterize patients undergoing urgent dialysis initiation and analyse its effect on survival outcome.
We retrospectively identified 208 patients who began haemodialysis from 1 January 2012 to 31 December 2018 at our hospital. In this observational case-control study, the case group comprised patients starting urgent dialysis, and the control group comprised patients starting planned dialysis. We analysed laboratory data, sex, age, smoking history, comorbidities and presence of vascular access and nephrology care that potentially affected the outcome. Data were analysed with Kaplan-Meier curves of early and late period (3 years after dialysis initiation) survival and log-rank tests and with Cox regression analysis.
Median age (range) at dialysis initiation was 73 (28-90) years, with 50 (24%) patients in the urgent initiation group. Five (10%) patients in this group had vascular access at dialysis initiation, whereas 21 (42%) had not received adequate pre-dialysis nephrology care. The estimated median overall survival rates of the urgent group and planned initiation group were 42 months and not reached, respectively (P = 0.0011). Multivariable analysis found urgent dialysis initiation to be an independent risk factor for survival (HR 2.36; 95% CI 1.36-4.00; P = 0.02). Survival was not significantly different between the groups for patients who continued chronic dialysis for > 3 years from dialysis initiation (P = 0.1339).
The prognosis of patients starting dialysis in an urgent condition was poor compared with those who started planned dialysis.
终末期肾病患者在紧急透析开始时的结局各不相同，但长期预后的证据有限。本研究旨在描述紧急透析开始的患者特征，并分析其对生存结局的影响。
我们回顾性地确定了 208 例于 2012 年 1 月 1 日至 2018 年 12 月 31 日期间在我院开始血液透析的患者。在这项观察性病例对照研究中，病例组包括开始紧急透析的患者，对照组包括开始计划透析的患者。我们分析了可能影响结局的实验室数据、性别、年龄、吸烟史、合并症以及血管通路和肾脏病学护理的存在情况。采用 Kaplan-Meier 曲线分析早期和晚期（透析开始后 3 年）生存情况，并进行 Log-rank 检验和 Cox 回归分析。
透析开始时的中位（范围）年龄为 73（28-90）岁，紧急开始组中有 50 例（24%）患者。该组中有 5 例（10%）患者在开始透析时即存在血管通路，而 21 例（42%）患者未接受充分的透析前肾脏病学护理。紧急组和计划开始组的估计中位总生存率分别为 42 个月和未达到（P=0.0011）。多变量分析发现紧急透析开始是生存的独立危险因素（HR 2.36；95%CI 1.36-4.00；P=0.02）。对于从透析开始后继续接受慢性透析>3 年的患者，两组之间的生存情况无显著差异（P=0.1339）。
与计划开始透析的患者相比，紧急开始透析的患者预后较差。
