尿素清除率和血清白蛋白浓度作为血液透析患者死亡率的预测指标。

The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis.

作者信息

Owen W F, Lew N L, Liu Y, Lowrie E G, Lazarus J M

机构信息

Brigham and Women's Hospital, Boston, MA 02115.

出版信息

N Engl J Med. 1993 Sep 30;329(14):1001-6. doi: 10.1056/NEJM199309303291404.

DOI:10.1056/NEJM199309303291404

PMID:8366899

Abstract

BACKGROUND

Among patients with end-stage renal disease who are treated with hemodialysis, solute clearance during dialysis and nutritional adequacy are determinants of mortality. We determined the effects of reductions in blood urea nitrogen concentrations during dialysis and changes in serum albumin concentrations, as an indicator of nutritional status, on mortality in a large group of patients treated with hemodialysis.

METHODS

We analyzed retrospectively the demographic characteristics, mortality rate, duration of hemodialysis, serum albumin concentration, and urea reduction ratio (defined as the percent reduction in blood urea nitrogen concentration during a single dialysis treatment) in 13,473 patients treated from October 1, 1990, through March 31, 1991. The risk of death was determined as a function of the urea reduction ratio and serum albumin concentration.

RESULTS

As compared with patients with urea reduction ratios of 65 to 69 percent, patients with values below 60 percent had a higher risk of death during follow-up (odds ratio, 1.28 for urea reduction ratios of 55 to 59 percent and 1.39 for ratios below 55 percent). Fifty-five percent of the patients had urea reduction ratios below 60 percent. The duration of dialysis was not predictive of mortality. The serum albumin concentration was a more powerful (21 times greater) predictor of death than the urea reduction ratio, and 60 percent of the patients had serum albumin concentrations predictive of an increased risk of death (values below 4.0 g per deciliter). The odds ratio for death was 1.48 for serum albumin concentrations of 3.5 to 3.9 g per deciliter and 3.13 for concentrations of 3.0 to 3.4 g per deciliter. Diabetic patients had lower serum albumin concentrations and urea reduction ratios than nondiabetic patients.

CONCLUSIONS

Low urea reduction ratios during dialysis are associated with increased odds ratios for death. These risks are worsened by inadequate nutrition.

摘要

背景

在接受血液透析治疗的终末期肾病患者中，透析期间的溶质清除率和营养充足程度是死亡率的决定因素。我们在一大群接受血液透析治疗的患者中，确定了透析期间血尿素氮浓度降低以及作为营养状况指标的血清白蛋白浓度变化对死亡率的影响。

方法

我们回顾性分析了1990年10月1日至1991年3月31日期间接受治疗的13473例患者的人口统计学特征、死亡率、血液透析持续时间、血清白蛋白浓度和尿素清除率（定义为单次透析治疗期间血尿素氮浓度的降低百分比）。根据尿素清除率和血清白蛋白浓度确定死亡风险。

结果

与尿素清除率为65%至69%的患者相比，尿素清除率低于60%的患者在随访期间死亡风险更高（尿素清除率为55%至59%时的比值比为1.28，低于55%时为1.39）。55%的患者尿素清除率低于60%。透析持续时间不能预测死亡率。血清白蛋白浓度比尿素清除率更能有力地预测死亡（预测能力强21倍），60%的患者血清白蛋白浓度预测死亡风险增加（低于4.0克/分升）。血清白蛋白浓度为3.5至3.9克/分升时死亡的比值比为1.48，浓度为3.0至3.4克/分升时为3.13。糖尿病患者的血清白蛋白浓度和尿素清除率低于非糖尿病患者。