意大利拉齐奥地区新血液透析患者的死亡率趋势和决定因素。

Trend and determinants of mortality in incident hemodialysis patients of the Lazio region.

机构信息

Servizio Emodialisi, Università Cattolica del Sacro Cuore facoltà di Medicina e Chirurgia, Rome, Italy.

Servizio Emodialisi, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.

出版信息

BMC Nephrol. 2023 Apr 26;24(1):111. doi: 10.1186/s12882-023-03170-w.

DOI:10.1186/s12882-023-03170-w

PMID:37101132

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10134676/

Abstract

BACKGROUND

. In the last decades some studies observed a moderate progressive decrease in short-term mortality in incident hemodialysis patients. The aim of the study is to analyse the mortality trends in patients starting hemodialysis using the Lazio Regional Dialysis and Transplant Registry.

METHODS

. Patients who started chronic hemodialysis between 2008 and 2016 were included. Annual 1-year and 3-year Crude Mortality Rate100 Person Years (CMR100PY) overall, by gender and age classes were calculated. Cumulative survival estimates at 1 year and 3 years since the date of starting hemodialysis were presented as Kaplan-Meier curves for the three periods and compared using the log-rank test. The association between periods of incidence in hemodialysis and 1-year and 3-year mortality were investigated by means of unadjusted and adjusted Cox regression models. Potential determinants of both mortality outcomes were also investigated.

RESULTS

. Among 6,997 hemodialysis patients (64.5% males, 66.1% over 65 years old) 923 died within 1 year and 2,253 within 3 years form incidence; CMR*100PY were 14.1 (95%CI: 13.2-15.0) and 13.7 (95%CI: 13.2-14.3), respectively; both remained unchanged over the years. Even after stratification by gender and age classes no significant changes emerged. Kaplan-Meier mortality curves did not show any statistically significant differences in survival at 1 year and 3 years from hemodialysis incidence across periods. No statistically significant associations were found between periods and 1-year and 3-year mortality. Factors associated with a greater increase in mortality are: being over 65 years, born in Italy, not being self-sufficient, having systemic versus undetermined nephropathy, having heart disease, peripheral vascular disease, cancer, liver disease, dementia and psychiatric illness, and receiving dialysis by catheter rather than fistula.

CONCLUSIONS

. The study shows that the mortality rate in patients with end-stage renal disease starting hemodialysis in the Lazio region was stable over 9 years.

摘要

背景

在过去的几十年中，一些研究观察到新进入血液透析的患者的短期死亡率呈适度的逐渐下降。本研究的目的是使用拉齐奥地区透析和移植登记处分析开始血液透析患者的死亡率趋势。

方法

纳入 2008 年至 2016 年期间开始接受慢性血液透析的患者。计算了总人群、按性别和年龄组划分的每年 1 年和 3 年的粗死亡率100 人年（CMR100PY）。以 Kaplan-Meier 曲线呈现开始血液透析后 1 年和 3 年的累积生存率，并使用对数秩检验比较 3 个时期的生存率。通过未调整和调整后的 Cox 回归模型研究血液透析发病率的时期与 1 年和 3 年死亡率之间的关系。还研究了死亡率结果的潜在决定因素。

结果

在 6997 名血液透析患者（64.5%为男性，66.1%年龄超过 65 岁）中，923 名患者在 1 年内死亡，2253 名患者在 3 年内死亡；CMR*100PY 分别为 14.1（95%CI：13.2-15.0）和 13.7（95%CI：13.2-14.3），均保持不变。即使按性别和年龄组分层，也没有出现显著变化。Kaplan-Meier 死亡率曲线在血液透析发病后 1 年和 3 年的生存率方面在各时期均无统计学差异。各时期与 1 年和 3 年死亡率之间无统计学关联。与死亡率增加相关的因素是：年龄超过 65 岁、出生在意大利、不能自理、患有系统性而非未确定的肾病、患有心脏病、外周血管疾病、癌症、肝病、痴呆和精神疾病，以及通过导管而不是瘘管接受透析。