Mailloux L U, Napolitano B, Bellucci A G, Mossey R T, Vernace M A, Wilkes B M
Division of Nephrology and Hypertension, North Shore University Hospital-Cornell University Medical College, Manhasset, NY 11030, USA.
ASAIO J. 1996 May-Jun;42(3):164-9.
By using a computerized database, we have catalogued the presence of 29 co-morbid risk factors in 683 patients with end-stage renal disease who started dialysis from 1970 through 1989, with follow-up through 1992. The authors hypothesized that current end-stage renal disease patients have more serious co-morbid risk factors impacting upon their mortality rate. Quantitation of dialysis patient co-morbidity, as a measure of patient illness, is lacking in the general nephrology literature. Seven co-morbid risk factors have been reserved for new dialysis patients: hypertension, low albumin, cerebral vascular disease, peripheral vascular disease, pre-existing cardiac disease, abnormal EKG/old myocardial infarction, and congestive heart failure. Except for low serum albumin, the proportion of patients with the six other co-morbid risk factors has increased significantly over this 20-year period (p < 0.0001, chi-square test for hypertension, peripheral vascular disease, pre-existing cardiac disease, abnormal EKG/old myocardial infarction, and congestive heart failure, and p < 0.006 for cerebral vascular disease). In addition, the co-morbid risk factors of hypertension, low serum albumin, and pre-existing cardiac disease at the start of dialysis were strongly prognostic of survival. The Cox proportional hazards regression model identified these three risks, among other factors, that were significantly associated with a decreased survival, with risk ratios ranging from 1.40-1.66. These results support the authors' hypothesis that incoming end-stage renal disease patients, who recently start dialysis, are sicker than in the earlier years of the authors' program. If the authors' patients reflect the national end-stage renal disease population, the presence of co-morbid risk factors may, in part, explain the continuing high mortality of dialysis patients.
通过使用计算机化数据库，我们梳理了1970年至1989年开始透析并随访至1992年的683例终末期肾病患者中29种共病风险因素的存在情况。作者推测，当前的终末期肾病患者有更严重的共病风险因素影响其死亡率。普通肾脏病学文献中缺乏对透析患者共病情况的量化，而这是衡量患者疾病程度的一种方式。有七种共病风险因素被预留用于新透析患者：高血压、低白蛋白、脑血管疾病、外周血管疾病、既往心脏病、心电图异常/陈旧性心肌梗死和充血性心力衰竭。除了低血清白蛋白外，在这20年期间，其他六种共病风险因素的患者比例显著增加（高血压、外周血管疾病、既往心脏病、心电图异常/陈旧性心肌梗死和充血性心力衰竭的卡方检验p<0.0001，脑血管疾病的p<0.006）。此外，透析开始时的高血压、低血清白蛋白和既往心脏病等共病风险因素对生存具有强烈的预后意义。Cox比例风险回归模型确定，除其他因素外，这三种风险与生存率降低显著相关，风险比在1.40至1.66之间。这些结果支持了作者的假设，即最近开始透析的新的终末期肾病患者比作者项目早期时病情更重。如果作者的患者反映了全国终末期肾病患者群体，那么共病风险因素的存在可能部分解释了透析患者持续的高死亡率。
