Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Nephrology, Peking University People's Hospital, Peking University, Beijing, China.
BMC Nephrol. 2023 Aug 15;24(1):236. doi: 10.1186/s12882-023-03271-6.
China has the largest number of patients on maintenance hemodialysis (MHD) worldwide. Despite continuous improvements in hemodialysis techniques, patients on MHD have a higher mortality rate than the general population. Understanding the characteristics of death in this population can better promote clinical practice, thereby improving patients' survival.
We collected demographic and clinical data for patients on MHD registered in the Beijing Blood Purification Quality Control and Improvement Center database from 2014 to 2020. The annual mortality rate was calculatedand the primary cause of end-stage renal disease (ESRD), dialysis vintage, and cause of death among deceased patients were analyzed.
(1) 24,363 patients on MHD were included, of which 6,065 patients died from 2014 to 2020. The annual mortality rate fluctuated between 7.4% and 8.0%. The median age of death was 70.0 (60.8-79.0) years and the male to female ratio was 1.27:1 (2). The top three primary causes of ESRD in deceased patients were chronic glomerulonephritis (CGN), diabetic nephropathy (DN), and hypertensive nephropathy (HN). Comparison of the annual mortality rate showed DN > HN > CGN (3). The median dialysis vintage of deceased patients was 3.7 (1.8-6.9) years, which slowly increased annually. Patients with diabetes had a shorter dialysis vintage than patients without diabetes (3.4 vs. 4.1 years, Z = 8.3, P < 0.001) (4). The major causes of death were cardiovascular disease (20.2%), sudden death (18.1%), infection (17.9%), and cerebrovascular disease (12.6%). Proportions of death from cardiovascular disease, infection, and sudden death were higher in patients with diabetes (22.2%, 20.2%, and 20.0%) than patients without diabetes (18.4%, 15.8%, and 16.3%). Sudden death was the leading cause of death in young (18-44 years; 27.0%) and middle aged (45-64 years; 20.8%) patients, whereas infection was the leading cause of death in patients aged ≥ 75 years (24.5%).
The annual mortality rate of patients on MHD in Beijing was relatively stable from 2014 to 2020. Sudden death was more likely to occur in young and middle-aged patients, and more patients aged ≥ 75 years died from infections.
中国是世界上维持性血液透析（MHD）患者数量最多的国家。尽管血液透析技术不断改进，但 MHD 患者的死亡率仍高于普通人群。了解该人群的死亡特征可以更好地促进临床实践，从而提高患者的生存率。
我们收集了 2014 年至 2020 年期间在北京血液净化质量控制和改进中心数据库中登记的 MHD 患者的人口统计学和临床数据。计算了每年的死亡率，并分析了终末期肾脏病（ESRD）的主要病因、透析龄和死亡患者的死因。
（1）共纳入 24363 例 MHD 患者，其中 2014 年至 2020 年期间有 6065 例患者死亡。每年的死亡率在 7.4%至 8.0%之间波动。死亡患者的中位年龄为 70.0（60.8-79.0）岁，男女比例为 1.27:1（2）。死亡患者 ESRD 的前三位主要病因是慢性肾小球肾炎（CGN）、糖尿病肾病（DN）和高血压肾病（HN）。年度死亡率比较显示 DN>HN>CGN（3）。死亡患者的中位透析龄为 3.7（1.8-6.9）年，每年缓慢增加。患有糖尿病的患者透析龄短于无糖尿病的患者（3.4 年 vs. 4.1 年，Z=8.3，P<0.001）（4）。主要死亡原因是心血管疾病（20.2%）、猝死（18.1%）、感染（17.9%）和脑血管疾病（12.6%）。患有糖尿病的患者心血管疾病、感染和猝死的死亡比例（22.2%、20.2%和 20.0%）高于无糖尿病的患者（18.4%、15.8%和 16.3%）。猝死是 18-44 岁（27.0%）和 45-64 岁（20.8%）年轻患者和中年患者的主要死亡原因，而感染是≥75 岁患者的主要死亡原因（24.5%）。
2014 年至 2020 年期间，北京 MHD 患者的年死亡率相对稳定。猝死更可能发生在年轻和中年患者中，而≥75 岁的患者更多死于感染。
