Okazaki Masaki, Obi Yoshitsugu, Shafi Tariq, Rhee Connie M, Kovesdy Csaba P, Kalantar-Zadeh Kamyar
Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA.
Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Kidney Int Rep. 2023 Aug 3;8(10):1989-2000. doi: 10.1016/j.ekir.2023.07.020. eCollection 2023 Oct.
The survival benefit of residual kidney function (RKF) in patients on hemodialysis is presumably due to enhanced fluid management and solute clearance. However, data are lacking on the association of renal urea clearance (CL) with specific causes of death.
We conducted a longitudinal cohort study of 39,623 adults initiating thrice-weekly in-center hemodialysis from 2007 to 2011 and had data on renal CL and urine volume. Multivariable cause-specific proportional hazards model was used to examine the associations between baseline RKF and cause-specific mortality, including sudden cardiac death (SCD), non-SCD cardiovascular death (CVD), and non-CVD. Restricted cubic splines were fitted for change in RKF over 6 months after initiating hemodialysis.
Among 39,623 patients with data on baseline renal CL and urine volume, there was a significant trend toward a higher mortality risk across lower RKF levels, irrespective of cause of death in a case-mix adjustment model ( < 0.05). Adjustment for ultrafiltration rate (UFR) slightly attenuated the association between low renal CL and high cause-specific mortality, whereas adjustment for highest potassium did not have substantial effect. Among 12,169 patients with data on change in RKF, a 6-month decline in renal CL showed graded associations with SCD, non-SCD CVD, and non-CVD risk, whereas the graded associations between faster 6-month decline in urine output and higher death risk were clear only for SCD and non-CVD.
Lower RKF and loss of RKF were associated with higher cause-specific mortality among patients initiating thrice-weekly in-center hemodialysis.
血液透析患者残余肾功能（RKF）带来的生存益处可能归因于强化的液体管理和溶质清除。然而，关于肾尿素清除率（CL）与特定死亡原因之间的关联，目前尚无相关数据。
我们对2007年至2011年开始每周进行三次中心血液透析的39623名成年人进行了一项纵向队列研究，并获取了肾CL和尿量的数据。使用多变量特定病因比例风险模型来检验基线RKF与特定病因死亡率之间的关联，包括心源性猝死（SCD）、非SCD心血管死亡（CVD）和非CVD。对开始血液透析后6个月内RKF的变化拟合受限立方样条。
在39623名有基线肾CL和尿量数据的患者中，在病例组合调整模型中，无论死亡原因如何，较低的RKF水平均呈现出较高的死亡风险趋势（P<0.05）。超滤率（UFR）的调整略微减弱了低肾CL与高特定病因死亡率之间的关联，而最高钾水平的调整则没有实质性影响。在12169名有RKF变化数据的患者中，肾CL在6个月内下降与SCD、非SCD CVD和非CVD风险呈现出分级关联，而尿量在6个月内下降越快与较高死亡风险之间的分级关联仅在SCD和非CVD中明显。
开始每周进行三次中心血液透析的患者中，较低的RKF和RKF丧失与较高的特定病因死亡率相关。
