Owen W F, Chertow G M, Lazarus J M, Lowrie E G
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
JAMA. 1998 Nov 25;280(20):1764-8. doi: 10.1001/jama.280.20.1764.
Although blacks receive lower doses of hemodialysis than whites, their survival when receiving dialysis treatment is better than that for whites. Previous studies of the relationship between the dose of dialysis and patient survival have not controlled for differences in patient characteristics.
To examine the association of mortality with the dose of hemodialysis for clusters of patients categorized by race and sex.
Retrospective analysis of laboratory data and mortality outcomes from 1994, using a national database of hemodialysis patients.
A total of 18144 black and white patients receiving hemodialysis 3 times weekly who either lived the entire year receiving hemodialysis or died.
The fractional reduction of urea in a single dialysis session as the measured hemodialysis dose (urea reduction ratio [URR]) after controlling for race, sex, age, and diabetes mellitus. Mortality was determined by strata of URRs and albumin and creatinine levels.
Across all age categories, blacks had lower URRs than whites, and men had lower URRs than women. In an age-adjusted model for evaluating interactions among URRs, race, sex, and diabetes, the association of URR with mortality risk was weak among blacks, particularly black men. After adjustment for age and diabetes, death probability curves were most steep for white women with URR values less than 60%. The death probability curves were least steep for black men. There was no meaningful difference between death probability and albumin or creatinine concentration among the race by sex clusters.
Using URR, the usual measure of hemodialysis dose, the assumption that the association between dialysis dose and survival is uniform across demographic groups appears incorrect. Comparisons of the quality of dialysis patient care should not rely on URR alone to predict patient survival.
尽管黑人接受的血液透析剂量低于白人，但他们在接受透析治疗时的生存率却高于白人。先前关于透析剂量与患者生存率之间关系的研究并未控制患者特征的差异。
研究按种族和性别分类的患者群体中，死亡率与血液透析剂量之间的关联。
利用全国血液透析患者数据库，对1994年的实验室数据和死亡率结果进行回顾性分析。
共有18144名黑人及白人患者，每周接受3次血液透析，他们要么全年接受透析治疗，要么已死亡。
在控制种族、性别、年龄和糖尿病因素后，单次透析治疗中尿素的分数降低作为测量的血液透析剂量（尿素降低率[URR]）。死亡率由URR、白蛋白和肌酐水平分层确定。
在所有年龄组中，黑人的URR低于白人，男性的URR低于女性。在评估URR、种族、性别和糖尿病之间相互作用的年龄校正模型中（年龄校正模型：在研究多个因素之间的关系时，通过统计方法对年龄因素进行调整，以更准确地分析其他因素之间的关系），URR与死亡风险之间的关联在黑人中较弱，尤其是黑人男性。在调整年龄和糖尿病因素后，URR值低于60%的白人女性的死亡概率曲线最陡峭。黑人男性的死亡概率曲线最平缓。在按性别分类的种族群体中，死亡概率与白蛋白或肌酐浓度之间没有显著差异。
使用URR（血液透析剂量的常用测量指标）时，透析剂量与生存率之间的关联在不同人口群体中是一致的这一假设似乎是不正确的。透析患者护理质量的比较不应仅依赖URR来预测患者生存率。
