Mailloux L U, Bellucci A G, Napolitano B, Mossey T, Wilkes B M, Bluestone P A
Division of Nephrology and Hypertension, North Shore University Hospital, Cornell University Medical College, Manhasset, New York 11030.
Clin Nephrol. 1994 Aug;42(2):127-35.
Survival estimates were performed on 683 chronic dialysis patients who started dialysis from 1970 through 1989 and followed through 1991. Patients were grouped by dialysis type, renal diagnosis, start-year group and age at start. During these 20 entry, years, the median starting age rose from 47 to 61 years. Patients with a renal diagnosis of diabetes mellitus or renal vascular disease increased to 41% of those starting dialysis during the last 8 years of study. Survival analysis for all of the 683 patients revealed a 51-month median survival and a 43% and 23% 5- and 10-year survival estimates, respectively. There was nearly a fourfold rise in the risk ratio as age increased from the youngest to oldest age groups. Home hemodialysis patients had the longest survival, 89% at 5 years; patients on CAPD had a 56% 5-year survival. In-center hemodialysis patients had a median survival of 48 months and a 5-year survival of 39%. Pairwise comparisons of the renal diagnostic groups found patients with polycystic kidneys, interstitial disease and chronic glomerulonephritis to have better survival than patients with diabetes mellitus, renal vascular disease or the "other" diagnoses (log-rank test, p < 0.001). Survival analyses showed age, renal diagnosis, race, type of dialysis and dialysis modality switch to be important predictors of survival. The results of the survival estimates, gross mortality rates and standardized mortality ratios were used as guides to the adequacy of dialysis and quality of care delivered for the years 1989 through 1992.
对1970年至1989年开始透析并随访至1991年的683例慢性透析患者进行了生存估计。患者按透析类型、肾脏诊断、起始年份组和起始年龄分组。在这20年的入组期间，起始年龄的中位数从47岁上升到61岁。在研究的最后8年中，肾脏诊断为糖尿病或肾血管疾病的患者增加到开始透析患者的41%。对所有683例患者的生存分析显示，中位生存期为51个月，5年和10年生存率估计分别为43%和23%。随着年龄从最年轻组增加到最年长组，风险比几乎增加了四倍。家庭血液透析患者的生存期最长，5年生存率为89%；持续性非卧床腹膜透析患者的5年生存率为56%。中心血液透析患者的中位生存期为48个月，5年生存率为39%。对肾脏诊断组的两两比较发现，多囊肾、间质性疾病和慢性肾小球肾炎患者的生存率高于糖尿病、肾血管疾病或“其他”诊断的患者（对数秩检验，p<0.001）。生存分析表明，年龄、肾脏诊断、种族、透析类型和透析方式转换是生存的重要预测因素。生存估计、总死亡率和标准化死亡率的结果被用作1989年至1992年透析充分性和护理质量的指导。
