Sato Masaya, Tateishi Ryosuke, Yasunaga Hideo, Matsui Hiroki, Fushimi Kiyohide, Ikeda Hitoshi, Yatomi Yutaka, Koike Kazuhiko
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
BJR Open. 2019 Jun 12;1(1):20190004. doi: 10.1259/bjro.20190004. eCollection 2019.
No previous study has evaluated the risks associated with transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma in patients on hemodialysis (HD) for end stage renal disease (ESRD), because invasive treatment is rarely performed for such patients. We used a nationwide database to investigate in-hospital mortality and complication rates following TACE in patients on HD for ESRD.
Using the Japanese Diagnosis Procedure Combination database, we enrolled patients on HD for ESRD who underwent TACE for hepatocellular carcinoma. For each patient, we randomly selected up to four non-dialyzed patients using a matched-pair sampling method based on the patient's age, sex, treatment hospital, and treatment year. In-hospital mortality and complication rates were compared between dialyzed and non-dialyzed patients following TACE.
We compared matched pairs of 1551 dialyzed and 5585 non-dialyzed patients. Although the complication rate did not differ between the dialyzed and non-dialyzed ESRD patients [5.7% 5.8%, respectively; odds ratio, 0.99; 95% confidence interval (0.79-1.23); = 0.90], the in-hospital mortality rate was significantly higher in dialyzed ESRD patients than in non-dialyzed patients [2.2% 0.97%, respectively; odds ratio, 2.21; 95% confidence interval (1.44-3.40); < 0.001]. Among the dialyzed patients, the mortality rate was not significantly associated with sex, age, Charlson comorbidity index, or hospital volume.
The in-hospital mortality rate following TACE was 2.2 % and was significantly higher in dialyzed than in non-dialyzed ESRD patients. The indications for TACE in HD-dependent patients should be considered carefully with respect to the therapeutic benefits risks.
In hospital mortality rate following TACE in dialyzed patients was more than twice compared to non-dialyzed patients. Post-procedural complication following TAE in ESRD onHD patients was 5.7%, and did not differ from that in non dialyzed patients.
既往尚无研究评估终末期肾病（ESRD）接受血液透析（HD）的肝细胞癌患者经动脉化疗栓塞术（TACE）的相关风险，因为此类患者很少接受侵入性治疗。我们利用全国性数据库调查了ESRD接受HD治疗的患者TACE术后的院内死亡率和并发症发生率。
利用日本诊断程序组合数据库，纳入因ESRD接受HD治疗且因肝细胞癌接受TACE的患者。对于每位患者，我们采用配对抽样方法，根据患者的年龄、性别、治疗医院和治疗年份，随机选择至多4名未接受透析的患者。比较TACE术后透析患者和未透析患者的院内死亡率和并发症发生率。
我们比较了1551例透析患者和5585例未透析患者的配对样本。虽然透析的ESRD患者和未透析的ESRD患者并发症发生率无差异[分别为5.7%和5.8%；优势比为0.99；95%置信区间（0.79 - 1.23）；P = 0.90]，但透析的ESRD患者院内死亡率显著高于未透析患者[分别为2.2%和0.97%；优势比为2.21；95%置信区间（1.44 - 3.40）；P < 0.001]。在透析患者中，死亡率与性别、年龄、Charlson合并症指数或医院规模无显著相关性。
TACE术后的院内死亡率为2.2%，透析的ESRD患者显著高于未透析患者。对于依赖HD的患者，应根据治疗益处和风险仔细考虑TACE的适应证。
透析患者TACE术后的院内死亡率是未透析患者的两倍多。ESRD接受HD治疗患者TAE术后的并发症发生率为5.7%，与未透析患者无差异。
