Department of Nephrology, Dalian municipal central hospital, No. 826, Southwest Road, Dalian, Liaoning Province, 116033, PR China.
BMC Nephrol. 2020 Nov 16;21(1):485. doi: 10.1186/s12882-020-02145-5.
The purpose of this study was to explore the effect of changing treatment to high-flux hemodialysis (HFHD) on mortality rate in patients with long-term low flux hemodialysis (LFHD).
The patients with end-stage renal disease (ESRD) who underwent LFHD with dialysis age more than 36 months and stable condition in our hospital before December 31, 2014 were included in this study. They were divided into control group and observation group. Propensity score matched method was used to select patients in the control group. The hemodialysis was performed 3 times a week for 4 h. The deadline for follow-up is December 31, 2018. End-point event is all-cause death. The survival rates of the two groups were compared and multivariate Cox regression analysis was carried out.
K-M survival analysis showed that the 1-year, 2-year, 3-year and 4-year survival rates of HFHD group were 98, 96, 96 and 96%, respectively. The 1-year, 2-year, 3-year and 4-year survival rates of LFHD group were 95, 85, 80 and 78%, respectively. Log-rank test showed that the survival rate of HFHD group was significantly higher than that of LFHD group (x= 7.278, P = 0.007). Multivariate Cox regression analysis showed that male, age, hemoglobin and low-throughput dialysis were independent predictors of death (P < 0.05). Compared with LFHD, HFHD can significantly reduce the mortality risk ratio of patients, as high as 86%.
The prognosis of patients with ESRD who performed long-term LFHD can be significantly improved after changing to HFHD.
本研究旨在探讨将长期低通量血液透析（LFHD）转换为高通量血液透析（HFHD）治疗对死亡率的影响。
纳入本研究的患者为 2014 年 12 月 31 日前在我院接受 LFHD 治疗且透析龄超过 36 个月、病情稳定的终末期肾病（ESRD）患者。将患者分为对照组和观察组。采用倾向评分匹配法选择对照组患者，每周透析 3 次，每次 4 小时。随访截止日期为 2018 年 12 月 31 日。终点事件为全因死亡。比较两组患者的生存率，并进行多因素 Cox 回归分析。
K-M 生存分析显示，HFHD 组 1 年、2 年、3 年和 4 年的生存率分别为 98%、96%、96%和 96%，LFHD 组分别为 95%、85%、80%和 78%。Log-rank 检验显示，HFHD 组的生存率明显高于 LFHD 组（x=7.278，P=0.007）。多因素 Cox 回归分析显示，男性、年龄、血红蛋白和低通量透析是死亡的独立预测因素（P<0.05）。与 LFHD 相比，HFHD 可显著降低患者的死亡风险比，高达 86%。
将长期 LFHD 治疗的 ESRD 患者转换为 HFHD 治疗，可显著改善患者预后。
