Ifudu O, Mayers J D, Cohen L S, Paul H, Brezsnyak W F, Avram M M, Herman A I, Friedman E A
SUNY Health Science Center at Brooklyn, NY, USA.
Am J Nephrol. 1996;16(2):118-23. doi: 10.1159/000168982.
Four hundred and thirty randomly selected hemodialysis patients, aged 20 years and over, were studied to identify risk factors for vascular access and nonvascular access-related hospitalizations in the immediately preceding 1 year. Risk estimates for hospitalization were assessed using a multinominal logistic analysis model. We measured functional status, utilizing a 14-point Karnofsky scale, and in a separate analysis of covariance, in which Karnofsky score was the outcome, we examined the relationships of age, gender, ethnicity, renal diagnosis, and hospitalization. Individual comparisons were adjusted for multiple comparison bias by Tukey's Honest Difference method. There were a total of 508 hospitalizations of which 322 (63%) lasted > or = 1 week. Two hundred and sixty (60%) patients were hospitalized at least once; 105 (24.4%) for access problems only, 115 (27%) for a nonaccess problem only, and 40 for access and nonaccess-related problems. Access-related problems, accounted for 48% of all hospitalizations. The risk of hemodialysis vascular access morbidity was increased in women (p < 0.028) and white (p < 0.048) hemodialysis patients. Neither diabetic nor elderly hemodialysis patients were at greater risk for access hospitalization than their respective counterparts, though a greater proportion of the access hospitalizations in the elderly (> or = 64 years) lasted > or = 1 week (p < 0.0006). More access-related hospitalizations in blacks (64.5%), lasted for > or = 1 week than in whites (40.6%) (p < 0.001). Hispanics (p < 0.043), whites (p < 0.002), and the older patients (p < 0.054) were at greater risk for nonaccess hospitalization than blacks and younger patients, respectively. Even after adjusting for age, race, and diabetes, each decrease of one unit in the modified Karnofsky score was associated with a 3-4% increased risk for all types of hospitalization (p < 0.001)--poor functional status is associated with increased risk for all hospitalizations. We conclude that the risk for hemodialysis vascular access morbidity is increased in women and white hemodialysis patients. Poor functional status is associated with increased risk for all hospitalizations.
对430名年龄在20岁及以上的随机选取的血液透析患者进行了研究，以确定在前1年中血管通路相关和非血管通路相关住院的危险因素。使用多项逻辑分析模型评估住院的风险估计值。我们采用14分的卡诺夫斯基量表测量功能状态，并且在一项以卡诺夫斯基评分作为结果的单独协方差分析中，我们研究了年龄、性别、种族、肾脏诊断和住院之间的关系。通过图基诚实差异法对个体比较进行调整以消除多重比较偏差。总共发生了508次住院，其中322次（63%）持续时间≥1周。260名（60%）患者至少住院1次；仅因血管通路问题住院的有105名（24.4%），仅因非血管通路问题住院的有115名（27%），因血管通路和非血管通路相关问题住院的有40名。与血管通路相关的问题占所有住院的48%。血液透析血管通路发病风险在女性（p<0.028）和白人血液透析患者（p<0.048）中增加。糖尿病血液透析患者和老年血液透析患者发生血管通路相关住院的风险并不高于各自的对照组，尽管老年患者（≥64岁）中血管通路相关住院的更大比例持续时间≥1周（p<0.0006）。黑人中与血管通路相关的住院持续时间≥1周的比例（64.5%）高于白人（40.6%）（p<0.001）。西班牙裔（p<0.043）、白人（p<0.002）和老年患者（p<0.054）分别比黑人和年轻患者发生非血管通路相关住院的风险更高。即使在对年龄、种族和糖尿病进行调整后，改良卡诺夫斯基评分每降低一个单位，各类住院风险增加3 - 4%（p<0.001）——功能状态差与所有住院风险增加相关。我们得出结论，女性和白人血液透析患者发生血液透析血管通路发病的风险增加。功能状态差与所有住院风险增加相关。
