Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Sci Rep. 2023 Aug 8;13(1):12867. doi: 10.1038/s41598-023-39913-w.
In Taiwan, most first-time dialysis was started without the creation of an arteriovenous shunt. Here, we aimed to elucidate the transitions of dialysis status in the unplanned first dialysis patients and determine factors associated with their outcomes. A total of 50,315 unplanned first dialysis patients aged more than 18 years were identified from the National Health Insurance Dataset in Taiwan between 2001 and 2012. All patients were followed for 5 years for the transitions in dialysis status, including robust (dialysis-free), sporadic dialysis, continued dialysis, and death. Furthermore, factors associated with the development of continued dialysis and death were examined by the Cox proportional hazard models. After 5 years after the first dialysis occurrence, there were 5.39% with robust status, 1.67% with sporadic dialysis, 8.45% with continued dialysis, and 84.48% with death. Notably, we have identified common risk factors for developing maintenance dialysis and deaths, including male gender, older age, diabetes, coronary heart disease, stroke, heart failure, sepsis, and surgery. There was an extremely high mortality rate among the first unplanned dialysis patients in Taiwan. Less than 10% of these patients underwent continued dialysis during the 5-year follow-up period. This study highlighted the urgent need for interventions to improve patient outcomes.
在台湾，大多数首次透析都是在未建立动静脉分流的情况下进行的。在这里，我们旨在阐明无计划首次透析患者的透析状态变化，并确定与他们的结果相关的因素。从 2001 年至 2012 年，我们从台湾全民健康保险数据集中共确定了 50315 名年龄大于 18 岁的无计划首次透析患者。所有患者在首次透析后 5 年内随访透析状态的变化，包括稳定（无透析）、偶发性透析、持续透析和死亡。此外，还通过 Cox 比例风险模型检查了与持续透析和死亡发展相关的因素。在首次透析发生后的 5 年内，有 5.39%的患者处于稳定状态，1.67%的患者进行偶发性透析，8.45%的患者进行持续透析，84.48%的患者死亡。值得注意的是，我们已经确定了发展为维持性透析和死亡的常见危险因素，包括男性、年龄较大、糖尿病、冠心病、中风、心力衰竭、败血症和手术。在台湾，首次无计划透析患者的死亡率极高。在 5 年的随访期间，这些患者中只有不到 10%接受了持续透析。这项研究强调了迫切需要采取干预措施来改善患者的预后。
