Avram M M, Bonomini L V, Sreedhara R, Mittman N
Department of Medicine, The Long Island College Hospital, Brooklyn, NY 11201, USA.
Am J Kidney Dis. 1996 Dec;28(6):910-7. doi: 10.1016/s0272-6386(96)90394-7.
Mortality among end-stage renal disease patients in the United States remains unacceptably high despite progress in the management of renal replacement therapy. Consequently, there are few reports of long-term survivors on dialysis. We have analyzed characteristics of long-term (10 to 15 years, N = 40) and very long-term (15 to 30 years, N = 18) survivors on hemodialysis and long-term survivors (more than 10 years, N = 28) on peritoneal dialysis and compared them with "average survivors" (< 5 years, N = 65 for hemodialysis and N = 101 for peritoneal dialysis). Among hemodialysis patients, long- and very long-term survival was associated with younger age, nondiabetic status, black race, and male gender (P < 0.05 for all variables). Enrollment creatinine was higher among long- and very long-term survivors, whereas albumin and hematocrit increased significantly during the period of observation among long- and very long-term survivors compared with average survivors. Enrollment age, nondiabetic status, and albumin level predicted prolonged survival even after adjustments for confounding variables. Among peritoneal dialysis patients, younger age and nondiabetic status predicted prolonged survival. Black race was associated with improved survival, but the association was not statistically significant. Enrollment levels of albumin and creatinine were significantly higher among long-term survivors and the cholesterol increased during the period of observation in long-term survivors. Thus, demographic and biochemical indices reflecting nutritional status can predict prolonged survival in hemodialysis and peritoneal dialysis. Patient survival for periods of up to 30 years is possible on renal replacement therapy. Analyses of these outlier patients may offer clues to prolonged survival.
尽管在肾脏替代治疗管理方面取得了进展，但美国终末期肾病患者的死亡率仍然高得令人无法接受。因此，关于透析长期存活者的报道很少。我们分析了血液透析长期（10至15年，N = 40）和极长期（15至30年，N = 18）存活者以及腹膜透析长期存活者（超过10年，N = 28）的特征，并将他们与“平均存活者”（<5年，血液透析N = 65，腹膜透析N = 101）进行比较。在血液透析患者中，长期和极长期存活与较年轻的年龄、非糖尿病状态、黑人种族和男性性别相关（所有变量P < 0.05）。长期和极长期存活者的入组肌酐水平较高，而与平均存活者相比，长期和极长期存活者在观察期内白蛋白和血细胞比容显著增加。即使在对混杂变量进行调整后，入组年龄、非糖尿病状态和白蛋白水平仍可预测生存期延长。在腹膜透析患者中，较年轻年龄和非糖尿病状态可预测生存期延长。黑人种族与生存期改善相关，但该关联无统计学意义。长期存活者的白蛋白和肌酐入组水平显著较高，且长期存活者在观察期内胆固醇升高。因此，反映营养状况的人口统计学和生化指标可预测血液透析和腹膜透析患者的生存期延长。通过肾脏替代治疗，患者存活长达30年是可能的。对这些异常患者的分析可能为延长生存期提供线索。
