标准 Kt/V 和表面积标准化标准 Kt/V 与血液透析患者临床结局的关系。
The association of standard Kt/V and surface area-normalized standard Kt/V with clinical outcomes in hemodialysis patients.
机构信息
Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
出版信息
Hemodial Int. 2020 Oct;24(4):495-505. doi: 10.1111/hdi.12865. Epub 2020 Aug 18.
INTRODUCTION
A previous study demonstrated that the surface area-normalized standard Kt/V (SAstdKt/V) was better associated with mortality than standard Kt/V (stdKt/V). This study investigates the association of SAstdKt/V and stdKt/V with mortality, anemia, and hypoalbuminemia in a larger patient cohort with a longer follow-up period.
METHODS
We included adult patients on thrice-weekly hemodialysis in the USRDS database and excluded amputated patients. StdKt/V and SAstdKt/V were calculated from the available single-pool Kt/V. Patients were categorized into five groups according to their stdKt/V and SAstdKt/V: <2.00, 2.00-2.19, 2.20-2.39, 2.40-2.59, and ≥2.60. Hazard ratios (HR) and odds ratios (OR) were calculated using Cox and logistic regression analysis respectively.
FINDINGS
There were 507,656 patients included in the analysis. The patients had a median age of 65.5 years with a median follow-up period of 2 years. Thirty-four percent died during follow-up. HRs for mortality progressively decreased as SAstdKt/V increased in both unadjusted and adjusted models. Unlike SAstdKt/V, HRs were the lowest in the categories with stdKt/V of 2.40-2.59 and they increased in the higher stdKt/V category. The adjusted HR for SAstdKt/V vs. stdKt/V were 0.68 vs. 0.62 in the category of 2.40-2.59, and 0.63 vs. 0.73 in the category of ≥2.60. The adjusted ORs for anemia progressively decreased as SAstdKt/V increased, whereas ORs decreased to the lowest in stdKt/V category 2.40-2.59 and increased in the ≥2.60 category. The adjusted ORs for hypoalbuminemia progressively decreased as SAstdKt/V and stdKt/V increased which were both 0.45 in 2.40-2.59 category and decreased to 0.29 and 0.42 in the ≥2.60 category.
DISCUSSION
SAstdKt/V is better associated with mortality, anemia, and hypoalbuminemia than stdKt/V. SAstdKt/V is a better parameter in defining hemodialysis dosing which can be calculated by an available online tool. Further studies to determine the optimal SAstdKt/V dose required to achieve improved clinical outcomes with better cost-effectiveness are needed.
简介
先前的研究表明，与标准 Kt/V（stdKt/V）相比，表面积标准化标准 Kt/V（SAstdKt/V）与死亡率的相关性更好。本研究在更大的患者队列中进行了更长的随访，探讨了 SAstdKt/V 和 stdKt/V 与死亡率、贫血和低白蛋白血症的相关性。
方法
我们纳入了美国肾脏数据系统（USRDS）数据库中每周接受三次血液透析的成年患者，并排除了截肢患者。从可用的单池 Kt/V 中计算 stdKt/V 和 SAstdKt/V。根据 stdKt/V 和 SAstdKt/V 将患者分为五组：<2.00、2.00-2.19、2.20-2.39、2.40-2.59 和≥2.60。使用 Cox 回归和 logistic 回归分析分别计算危险比（HR）和比值比（OR）。
结果
共纳入 507656 名患者。患者的中位年龄为 65.5 岁，中位随访时间为 2 年。34%的患者在随访期间死亡。在未调整和调整后的模型中，SAstdKt/V 越高，死亡率的 HR 越低。与 SAstdKt/V 不同，HR 在 stdKt/V 为 2.40-2.59 的类别中最低，并且在较高的 stdKt/V 类别中增加。在 stdKt/V 为 2.40-2.59 的类别中，SAstdKt/V 与 stdKt/V 的调整 HR 分别为 0.68 和 0.62，在 stdKt/V 为≥2.60 的类别中，调整 HR 分别为 0.63 和 0.73。随着 SAstdKt/V 的增加，贫血的调整 OR 逐渐降低，而在 stdKt/V 为 2.40-2.59 的类别中，OR 降至最低，并在≥2.60 的类别中增加。随着 SAstdKt/V 和 stdKt/V 的增加，低白蛋白血症的调整 OR 逐渐降低，在 2.40-2.59 类别中均为 0.45，在≥2.60 类别中降至 0.29 和 0.42。
讨论
与 stdKt/V 相比，SAstdKt/V 与死亡率、贫血和低白蛋白血症的相关性更好。SAstdKt/V 是定义血液透析剂量的更好参数，可通过可用的在线工具计算。需要进一步研究确定实现改善的临床结果和更好的成本效益所需的最佳 SAstdKt/V 剂量。
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