维持性透析治疗患者的肾功能恢复：来自 ERA-EDTA 登记处的报告。

Recovery of kidney function in patients treated with maintenance dialysis-a report from the ERA-EDTA Registry.

机构信息

Department of Internal Medicine and Nephrology, Dianet Dialysis Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Department of Medical Informatics, European Renal Association-European Dialysis and Transplant Association Registry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.

出版信息

Nephrol Dial Transplant. 2021 May 27;36(6):1078-1087. doi: 10.1093/ndt/gfaa368.

DOI:10.1093/ndt/gfaa368

PMID:33355661

Abstract

BACKGROUND

Literature on recovery of kidney function (RKF) in patients with end-stage kidney disease treated with maintenance dialysis (i.e. >90 days) is limited. We assessed the incidence of RKF and its associated characteristics in a European cohort of dialysis patients.

METHODS

We included adult patients from the European Renal Association-European Dialysis and Transplant Association Registry who started maintenance dialysis in 1997-2016. Sustained RKF was defined as permanent discontinuation of dialysis. Temporary discontinuation of ≥30 days (non-sustained RKF) was also evaluated. Factors associated with RKF adjusted for potential confounders were studied using Cox regression analyses.

RESULTS

RKF occurred in 7657 (1.8%) of 440 996 patients, of whom 71% experienced sustained RKF. Approximately 90% of all recoveries occurred within the first 2 years after Day 91 of dialysis. Of patients with non-sustained RKF, 39% restarted kidney replacement therapy within 1 year. Sustained RKF was strongly associated with the following underlying kidney diseases (as registered by the treating physician): tubular necrosis (irreversible) or cortical necrosis {adjusted hazard ratio [aHR] 20.4 [95% confidence interval (CI) 17.9-23.1]}, systemic sclerosis [aHR 18.5 (95% CI 13.8-24.7)] and haemolytic uremic syndrome [aHR 17.3 (95% CI 13.9-21.6)]. Weaker associations were found for haemodialysis as a first dialysis modality [aHR 1.5 (95% CI 1.4-1.6)] and dialysis initiation at an older age [aHR 1.8 (95% CI 1.6-2.0)] or in a more recent time period [aHR 2.4 (95% CI 2.1-2.7)].

CONCLUSIONS

Definitive discontinuation of maintenance dialysis is a rare and not necessarily an early event. Certain clinical characteristics, but mostly the type of underlying kidney disease, are associated with a higher likelihood of RKF.

摘要

背景

关于接受维持性透析（即>90 天）的终末期肾病患者肾功能恢复（RKF）的文献有限。我们评估了欧洲透析患者队列中 RKF 的发生率及其相关特征。

方法

我们纳入了 1997 年至 2016 年期间在欧洲肾脏协会-欧洲透析和移植协会登记处开始维持性透析的成年患者。永久性停止透析定义为持续 RKF。还评估了持续时间≥30 天的暂时停止透析（非持续 RKF）。使用 Cox 回归分析研究了与 RKF 相关的因素，这些因素经过了潜在混杂因素的调整。

结果

在 440996 名患者中，有 7657 名（1.8%）发生了 RKF，其中 71%为持续 RKF。所有恢复中约 90%发生在透析后第 91 天的前 2 年内。非持续 RKF 的患者中，39%在 1 年内重新开始肾脏替代治疗。持续 RKF 与以下基础肾脏疾病密切相关（由治疗医生登记）：肾小管坏死（不可逆）或皮质坏死{校正后的危险比[aHR]20.4[95%置信区间（CI）17.9-23.1]}、系统性硬化症[aHR 18.5（95%CI 13.8-24.7)]和溶血尿毒综合征[aHR 17.3（95%CI 13.9-21.6)]。作为首次透析方式的血液透析[aHR 1.5（95%CI 1.4-1.6)]、年龄较大时[aHR 1.8（95%CI 1.6-2.0)]或在更新的时间段内[aHR 2.4（95%CI 2.1-2.7)]开始透析与 RKF 的相关性较弱。