居家血液透析和腹膜透析患者的心血管结局。

Cardiovascular Outcomes in Patients on Home Hemodialysis and Peritoneal Dialysis.

机构信息

Division of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio.

Satellite Healthcare, San Jose, California.

出版信息

Kidney360. 2024 Feb 1;5(2):205-215. doi: 10.34067/KID.0000000000000360.

DOI:10.34067/KID.0000000000000360

PMID:38297433

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10914201/

Abstract

KEY POINTS

Home hemodialysis is associated with decreased risk of stroke and acute coronary syndrome relative to peritoneal dialysis. Home hemodialysis is associated with decreased risk of cardiovascular death and all-cause death relative to peritoneal dialysis.

BACKGROUND

Cardiovascular disease is the leading cause of morbidity and mortality in patients with ESKD. Little is known about differences in cardiovascular outcomes between home hemodialysis (HHD) and peritoneal dialysis (PD).

METHODS

We evaluated 68,645 patients who initiated home dialysis between January 1, 2005, and December 31, 2018, using the United States Renal Data System with linked Medicare claims. Rates for incident cardiovascular events of acute coronary syndrome, heart failure, and stroke hospitalizations were determined. Using adjusted time-to-event models, the associations of type of home dialysis modality with the outcomes of incident cardiovascular events, cardiovascular death, and all-cause death were examined.

RESULTS

Mean age of patients in the study cohort was 64±15 years, and 42.3% were women. The mean time of follow-up was 1.8±1.6 years. The unadjusted cardiovascular event rate was 95.1 per thousand person-years (PTPY) (95% confidence interval [CI], 93.6 to 96.8), with a higher rate in patients on HHD than on PD (127.8 PTPY; 95% CI, 118.9 to 137.2 versus 93.3 PTPY; 95% CI, 91.5 to 95.1). However, HHD was associated with a slightly lower adjusted risk of cardiovascular events than PD (hazard ratio [HR], 0.92; 95% CI, 0.85 to 0.997). Compared with patients on PD, patients on HHD had 42% lower adjusted risk of stroke (HR, 0.58; 95% CI, 0.48 to 0.71), 17% lower adjusted risk of acute coronary syndrome (HR, 0.83; 95% CI, 0.72 to 0.95), and no difference in risk of heart failure (HR, 1.05; 95% CI, 0.94 to 1.16). HHD was associated with 22% lower adjusted risk of cardiovascular death (HR, 0.78; 95% CI, 0.71 to 0.86) and 8% lower adjusted risk of all-cause death (HR, 0.92; 95% CI, 0.87 to 0.97) as compared with PD.

CONCLUSIONS

Relative to PD, HHD is associated with decreased risk of stroke, acute coronary syndrome, cardiovascular death, and all-cause death. Further studies are needed to better understand the factors associated with differences in cardiovascular outcomes by type of home dialysis modality in patients with kidney failure.

摘要

要点

与腹膜透析相比，家庭血液透析与降低中风和急性冠状动脉综合征的风险相关。与腹膜透析相比，家庭血液透析与降低心血管死亡和全因死亡的风险相关。

背景

心血管疾病是终末期肾病患者发病率和死亡率的主要原因。关于家庭血液透析（HHD）和腹膜透析（PD）之间心血管结局的差异知之甚少。

方法

我们使用美国肾脏数据系统（United States Renal Data System）和相关的医疗保险索赔数据，评估了 2005 年 1 月 1 日至 2018 年 12 月 31 日期间开始家庭透析的 68645 名患者。确定了急性冠状动脉综合征、心力衰竭和中风住院的心血管事件发生率。使用调整后的时间事件模型，研究了家庭透析模式与心血管事件、心血管死亡和全因死亡的关系。

结果

研究队列中患者的平均年龄为 64±15 岁，42.3%为女性。平均随访时间为 1.8±1.6 年。未经调整的心血管事件发生率为每千人每年 95.1 例（95%置信区间[CI]，93.6 至 96.8），HHD 患者的发生率高于 PD 患者（127.8 例/千人年；95%CI，118.9 至 137.2 与 93.3 例/千人年；95%CI，91.5 至 95.1）。然而，与 PD 相比，HHD 与较低的心血管事件风险相关（风险比[HR]，0.92；95%CI，0.85 至 0.997）。与 PD 患者相比，HHD 患者的中风调整后风险降低 42%（HR，0.58；95%CI，0.48 至 0.71），急性冠状动脉综合征的调整后风险降低 17%（HR，0.83；95%CI，0.72 至 0.95），心力衰竭的风险无差异（HR，1.05；95%CI，0.94 至 1.16）。与 PD 相比，HHD 患者的心血管死亡调整后风险降低 22%（HR，0.78；95%CI，0.71 至 0.86），全因死亡调整后风险降低 8%（HR，0.92；95%CI，0.87 至 0.97）。