新入维持性血液透析患者2年内死亡的危险因素

doi:10.6040/j.issn.1671-7554.0.2023.1106

摘要/Abstract

摘要： 目的探讨新入维持性血液透析(maintenance hemodialysis, MHD)患者2年内死亡的危险因素。方法收集2019年3月至2020年11月于山东大学第二医院开始血液透析患者的2年临床资料。按2年时是否死亡分为死亡组和存活组,比较临床资料,分析死亡的危险因素。以透析前收缩压(systolic blood pressure, SBP)分组比较患者死亡情况。最后利用单因素及多因素Cox回归,分析患者死亡的独立危险因素。结果在观察期间,共83例患者新入MHD,2年内转院4例,肾移植3例。纳入的76例中,死亡17例,占22.4%。与存活组相比,死亡组患者基线时血钾、白蛋白、血肌酐、SBP较低,合并冠心病及糖尿病比例较高,估计肾小球滤过率较高;SBP≤140 mmHg(1 mmHg=0.133 kPa)的患者病死率更高;Cox回归分析发现透析前较低的SBP(HR=0.957, 95%CI: 0.928~0.987)、低白蛋白(HR=0.918, 95%CI: 0.857~0.984)、合并糖尿病(HR=3.690, 95%CI: 1.157~11.768)是患者死亡的独立危险因素(P<0.05)。结论新入MHD患者病死率较高,SBP≤140 mmHg提示患者死亡风险较高,较低的透析前SBP、较低的白蛋白、合并糖尿病为其2年内死亡的危险因素。

关键词: 维持性血液透析, 透析前血压, 死亡风险, 危险因素

Abstract: Objective To explore the risk factors for death within 2 years in patients newly admitted to maintenance haemodialysis(MHD). Methods The 2-year clinical data of patients who started haemodialysis from March 2019 to November 2020 in The Second Hospital, Cheeloo College of Medicine, Shandong University were retrospectively collected. They were divided into death group and survival group according to whether they had died at 2 years. The clinical data were compared and the risk factors for death were analyzed. The patients were grouped by pre-dialysis systolic blood pressure(SBP)to compare the impact of blood pressure. Finally, the independent risk factors for patient death were analyzed using univarite and mnltivariate Cox regression models. Results During the observation period, a total of 83 patients were newly admitted to MHD, 4 left within 2 years, and 3 received renal transplant. Of the 76 cases included, 17(22.4%)died. Compared with the survival group, patients in the death group had lower blood potassium, albumin, blood creatinine, and SBP at baseline, a higher proportion of comorbid coronary artery disease and diabetes mellitus, and a higher estimated glomerular filtration rate; patients with an SBP ≤140 mmHg(1 mmHg=0.133 kPa)had a higher case-fatality rate. Cox regression analysis revealed that the lower pre-dialysis SBP(HR=0.957, 95%CI: 0.928-0.987), albumin(HR=0.918, 95%CI: 0.857-0.984), and comorbid diabetes mellitus(HR=3.690, 95%CI: 1.157-11.768)were found to be independent risk factors for death in patients(P<0.05). Conclusion Newly admitted MHD patients have a high case-fatality rate; SBP≤140 mmHg suggests higher risk of death; lower pre-dialysis SBP, albumin, and comorbid diabetes mellitus are risk factors for their death within 2 years.

Key words: Maintenance haemodialysis, Pre-dialysis blood pressure, Risk of death, Risk factors

中图分类号:

R459.5

李建,孙云. 新入维持性血液透析患者2年内死亡的危险因素[J]. 山东大学学报 (医学版), 2024, 62(4): 48-53.

LI Jian, SUN Yun. Risk factors for death within 2 years in new maintenance haemodialysis patients[J]. Journal of Shandong University (Health Sciences), 2024, 62(4): 48-53.

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