Iseki K, Uehara H, Nishime K, Tokuyama K, Yoshihara K, Kinjo K, Shiohira Y, Fukiyama K
Third Department of Internal Medicine, University of The Ryukyus, Okinawa, Japan.
Am J Kidney Dis. 1996 Oct;28(4):541-8. doi: 10.1016/s0272-6386(96)90465-5.
Besides the age at start of dialysis and the presence of diabetes mellitus, serum albumin has been shown to be a significant predictor of survival in prevalent dialysis patients. However, this was not evaluated in incipient dialysis patients. The initial biochemical variables were retrieved for a large dialysis population (N = 1,982) who were started on chronic dialysis in Okinawa, Japan from 1971 to 1990. Biochemical data that included blood urea nitrogen, serum creatinine, serum electrolytes (sodium, potassium, calcium, and phosphate), total cholesterol, triglyceride, total protein, serum albumin, and hematocrit obtained just before the first dialysis session were available for 1,491 (75.2%) patients. Six hundred sixty-four (43.2%) patients died by the end of 1993. Cox proportional analysis adjusted for sex, age, year of start of dialysis, presence of diabetes mellitus, and the laboratory variables was performed to examine the significance of the initial biochemical data on survival. The risk ratio was 0.577 (P = 0.0025) in serum albumin, 1.291 (P = 0.0138) in serum potassium, and 0.966 (P = 0.0202) in serum sodium. The study results support the notion that nutritional status is important for survival in chronic dialysis patients. Causes of hypoalbuminemia, hyperkalemia, and hyponatremia should be evaluated carefully at initiation of dialysis.
除了开始透析时的年龄和糖尿病的存在外，血清白蛋白已被证明是维持性透析患者生存的重要预测指标。然而，在初始透析患者中并未对此进行评估。我们收集了1971年至1990年在日本冲绳开始接受慢性透析的大量透析人群（N = 1,982）的初始生化变量。1,491名（75.2%）患者可获得首次透析前的生化数据，包括血尿素氮、血清肌酐、血清电解质（钠、钾、钙和磷）、总胆固醇、甘油三酯、总蛋白、血清白蛋白和血细胞比容。到1993年底，664名（43.2%）患者死亡。进行了Cox比例分析，对性别、年龄、透析开始年份、糖尿病的存在以及实验室变量进行了调整，以检验初始生化数据对生存的意义。血清白蛋白的风险比为0.577（P = 0.0025），血清钾为1.291（P = 0.0138），血清钠为0.966（P = 0.0202）。研究结果支持营养状况对慢性透析患者生存很重要这一观点。在开始透析时，应仔细评估低白蛋白血症、高钾血症和低钠血症的原因。
