Abe Masanori, Masakane Ikuto, Wada Atsushi, Nakai Shigeru, Nitta Kosaku, Nakamoto Hidetomo
The Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.
Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
Front Med (Lausanne). 2021 Aug 27;8:740461. doi: 10.3389/fmed.2021.740461. eCollection 2021.
Dialyzers are classified as low-flux, high-flux, and protein-leaking membrane dialyzers internationally and as types I, II, III, IV, and V based on β-microglobulin clearance rate in Japan. Type I dialyzers correspond to low-flux membrane dialyzers, types II and III to high-flux membrane dialyzers, and types IV and V to protein-leaking membrane dialyzers. Here we aimed to clarify the association of dialyzer type with mortality. This nationwide retrospective cohort study analyzed data from the Japanese Society for Dialysis Therapy Renal Data Registry from 2010 to 2013. We enrolled 238,321 patients on hemodialysis who were divided into low-flux, high-flux, and protein-leaking groups in the international classification and into type I to V groups in the Japanese classification. We assessed the associations of each group with 3-year all-cause mortality using Cox proportional hazards models and performed propensity score matching analysis. By the end of 2013, 55,308 prevalent dialysis patients (23.2%) had died. In the international classification subgroup analysis, the hazard ratio (95% confidence interval) was significantly higher in the low-flux group [1.12 (1.03-1.22), = 0.009] and significantly lower in the protein-leaking group [0.95 (0.92-0.98), = 0.006] compared with the high-flux group after adjustment for all confounders. In the Japanese classification subgroup analysis, the hazard ratios were significantly higher for types I [1.10 (1.02-1.19), = 0.015] and II [1.10 (1.02-1.39), = 0.014] but significantly lower for type V [0.91 (0.88-0.94), < 0.0001] compared with type IV after adjustment for all confounders. These significant findings persisted after propensity score matching under both classifications. Hemodialysis using protein-leaking dialyzers might reduce mortality rates. Furthermore, type V dialyzers are superior to type IV dialyzers in hemodialysis patients.
在国际上，透析器被分为低通量、高通量和蛋白渗漏膜透析器；在日本，透析器则根据β-微球蛋白清除率分为I、II、III、IV和V型。I型透析器对应低通量膜透析器，II型和III型对应高通量膜透析器，IV型和V型对应蛋白渗漏膜透析器。在此，我们旨在阐明透析器类型与死亡率之间的关联。这项全国性回顾性队列研究分析了日本透析治疗学会肾脏数据登记处2010年至2013年的数据。我们纳入了238,321名接受血液透析的患者，这些患者在国际分类中被分为低通量、高通量和蛋白渗漏组，在日本分类中被分为I至V组。我们使用Cox比例风险模型评估了每组与3年全因死亡率的关联，并进行了倾向评分匹配分析。到2013年底，55,308名透析患者（23.2%）死亡。在国际分类亚组分析中，在对所有混杂因素进行调整后，与高通量组相比，低通量组的风险比（95%置信区间）显著更高[1.12（1.03 - 1.22），P = 0.009]，而蛋白渗漏组显著更低[0.95（0.92 - 0.98），P = 0.006]。在日本分类亚组分析中，在对所有混杂因素进行调整后，与IV型相比，I型[1.10（1.02 - 1.19），P = 0.015]和II型[1.10（1.02 - 1.39），P = 0.014]的风险比显著更高，但V型[0.91（0.88 - 0.94）, P < 0.0001]显著更低。在两种分类下进行倾向评分匹配后，这些显著结果依然存在。使用蛋白渗漏透析器进行血液透析可能会降低死亡率。此外，在血液透析患者中，V型透析器优于IV型透析器。
