维持性血液透析患者自体动静脉内瘘失功的影响因素分析

目的：回顾性分析维持性血液透析患者自体动静脉内瘘（AVF）失功的影响因素。方法：以我院血透中心73例首次发生自体AVF失功的患者为内瘘失功组,选取同期自体AVF功能良好的136例维持性血液透析患者为内瘘通畅组,比较两组患者各项临床及生化指标,分别进行单因素分析及logistic回归分析。结果：内瘘失功组和通畅组在年龄、糖尿病、血红蛋白、血清白蛋白、血小板、三酰甘油、血清铁、C反应蛋白（CRP）、血钾、血磷、甲状旁腺激素（PTH）等方面差异存在统计学意义（P〈0.05）;logistic回归分析显示患有糖尿病（OR=1.551）,血清白蛋白（OR=1.061）、三酰甘油（OR=1.275）、血磷（OR=1.580）水平是内瘘失功的危险因素;内瘘失功组的生存分析显示糖尿病患者内瘘的中位生存时间为7个月,非糖尿病患者为27个月,差异有统计学意义（P=0.002）;分别进行内瘘失功组和通畅组的组内比较,糖尿病患者与非糖尿病患者在血清白蛋白、三酰甘油、血磷方面差异存在统计学意义（P〈0.05）。结论：糖尿病、血清白蛋白、三酰甘油、血磷水平是内瘘失功的危险因素,糖尿病患者内瘘使用时间明显短于非糖尿病患者,其影响因素与血清白蛋白、三酰甘油、血磷水平密切相关。     

经皮腔内血管成形术后内瘘再狭窄的相关危险因素探讨

目的 探讨经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)后再狭窄的相关危险因素,为延长内瘘使用时间提供诊疗依据。方法 回顾性纳入2020年1月1日至2021年1月1日在北京大学第三医院海淀院区肾内科因动静脉内瘘狭窄接受超声引导下PTA治疗并规律随访的血液透析患者335例,收集其基本数据包括基础病史、合并症、相关血清学指标、内瘘手术操作及术后随访资料,采用Cox比例风险模型分析影响PTA术后内瘘再狭窄的危险因素。结果 共纳入335例患者,其中男187例(55.82%),女148例(44.18%)。PTA术后6个月时的初级通畅率为77.31%,12个月时的初级通畅率为50.15%。Kaplan-Meier生存分析结果显示术后12个月,内瘘类型为人工血管动静脉内瘘的患者初级通畅率在随访时间内明显低于自体动静脉内瘘的患者(Log-rankχ²=719.522,P<0.001);陈旧性病变患者的初级通畅率在随访时间内明显低于新发病变的患者(Log-rankχ²=23.106,P<0....     

糖尿病对于血液透析患者全因死亡风险的预测研究

目的:探讨糖尿病(diabetes mellitus, DM)对维持性血液透析(maintenance hemodialysis, MHD)患者全因死亡风险的预测作用。方法:选取2018年01月—2019年12月在上海市浦东新区浦南医院维持性血液透析的患者115例。检测一般生化指标及是否合并糖尿病,随访至2020年12月,记录全因死亡事件发生。应用多元logistics回归模型评估糖尿病对于MHD患者全因死亡的预测作用,应用Kaplan-Meier函数曲线评估糖尿病MHD患者全因死亡发生风险。结果:共有115例MHD患者入选,随访期间共发生全因死亡事件21例。校正传统危险因素后,多因素logistics回归分析显示,糖尿病是血液透析患者发生全因死亡的高危因素,Kaplan-Meier函数曲线评估结果提示,在MHD患者中,糖尿病患者群发生全因死亡风险较非糖尿病患者群更高(P<0.05)。另外通过多因素logistics回归分析发现,低蛋白血症、高龄是糖尿病MHD患者发生全因死亡的高危因素,ROC曲线分析显示,白蛋白、年龄在糖尿病MHD患者中评判全因死亡有统计学意义,白蛋白曲线下面积...     

上肢移植物动静脉内瘘术后初级通畅时间及短期通畅率的影响因素分析

目的 探讨影响上肢移植物动静脉内瘘（arteriovenous graft,AVG）术后初级通畅时间及短期通畅率的可能因素。方法 回顾性选取2015年1月1日至2021年6月30日在广州医科大学第六附属医院肾内科建立上肢AVG的维持性血液透析患者,收集患者的临床数据,通过Kaplan-Meier生存分析、Cox风险回归分析、logistic回归分析,探寻影响AVG术后初期通畅时间及术后1年初级通畅率的可能因素。结果 共纳入163例符合筛选要求的患者,Kaplan-Meier生存分析结果显示AVG术后3、6、12个月的初级通畅率分别为93.9%、90.2%、81.6%。以肱动脉及贵要静脉为吻合血管建立AVG与以肱动脉及肘正中静脉为吻合血管建立AVG相比,其发生功能障碍的风险更高（Log-rank检验χ2=8.302,P=0.004）;有同侧自体动静脉内瘘（arteriovenous fistula,AVF）闭塞史的患者发生AVG功能障碍的风险高于无AVF闭塞史的患者（Log-rank检验χ2=6.387,P=0.011）;维持性服用抗血小板药物的患者发生AVG功能障碍的风险低于未服用抗血...     

维持性血液透析患者AVF早期失功的危险因素分析

目的探讨维持性血液透析患者动静脉内瘘(AVF)早期失功的危险影响因素。方法选取2017年1月至2021年3月在本院拟行维持性血液透析治疗的276例患者为研究对象, AVF建立后随访3个月, 最终纳入258例患者。根据患者AVF功能分为失功组(100例)和通畅组(158例);采用logistic回归分析AVF失功的影响因素, 构建维持性血液透析患者AVF早期失功风险的预测模型并分析其预测效能。结果两组患者的动脉粥样硬化、AVF吻合口长度、术中血流量、总胆固醇、血小板计数、纤维蛋白原、血红蛋白、钙磷乘积水平比较, 差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示:动脉粥样硬化(OR=2.910)、术中低血流量(OR=1.123)、总胆固醇(OR=1.012)、高血小板计数(OR=1.893)、纤维蛋白原(OR=1.429)、钙磷乘积(OR=2.721)是AVF早期失功的危险因素(均P<0.05);据此构建的预测模型预测AVF失功的受试者工作特征(ROC)曲线下面积为0.938(95%CI: 0.810～0.973), 灵敏度为86.00%, 特异度为97...     

维持性血液透析患者镁代谢紊乱及冠状动脉钙化的相关影响因素研究

目的:研究维持性血液透析(MHD)患者镁代谢紊乱以及冠状动脉钙化的相关影响因素。方法:临床纳入2017年06月～2018年06月期间在我院进行维持性血液透析的98例患者作为研究对象。收集患者临床资料和生化检验结果,分析MHD患者的血镁水平,根据血镁情况进行分组,观察影响MHD患者血镁的因素。采用多层螺旋计算机断层扫描(MSCT)测定MHD患者冠状动脉钙化积分(CACs)情况,按照CACs进行分组,观察影响MHD患者CACs的因素。结果:三组患者糖尿病病史、血磷、前白蛋白以及白蛋白水平对比差异有统计学意义(P 0. 05)。其中低血镁组患者糖尿病病史比例高于其他组,血磷、前白蛋白以及白蛋白水平均低于其他组,差异有统计学意义(P 0. 05)。三组患者年龄、糖尿病病史以及血镁水平对比差异有统计学意义(P 0. 05)。其中无钙化组患者年龄小于其他组,糖尿病病史比例低于其他组,差异有统计学意义(P 0. 05)。而无钙化组、轻中度钙化组血镁水平高于重度钙化组,差异有统计学意义(P 0. 05)。结论:维持性血液透析患者糖尿病病史、低白蛋白血症、冠状动脉钙化以及血磷代谢紊乱与低镁血症的发生密切相关,冠状动脉钙化程度与高龄、血镁水平有密切关系。年龄越大、血镁水平越低,越有可能发生冠状动脉钙化。     

血液透析动静脉内瘘功能的影响因素及预测模型的建立

目的:探讨维持性血液透析(MHD)患者动静脉内瘘功能的影响因素,并建立功能评估的预测模型.方法:选择本院血液净化中心使用自体动静脉内瘘(AVF)的MHD患者84例,根据内瘘血流量是否达标分为对照组和试验组,收集并记录患者一般资料及相关实验室检查结果进行统计学分析.结果:单因素分析显示两组间在是否合并糖尿病、是否应用抗血...     

非肌层浸润性膀胱癌并糖尿病患者的预后及其意义

目的:探讨非肌层浸润性膀胱癌(non-muscle-invasive bladder cancer,NMIBC)合并糖尿病患者的预后及意义。方法:回顾性分析我院2012年1月~2013年12月经病理检查回报为NMIBC的200例患者临床资料,将患者分为糖尿病组(41例)和非糖尿病组(159例)。所有患者均为首发尿路上皮癌。运用Kaplan-Meier法单因素分析各临床病理特点对患者无复发生存期(recurrence-free survival,RFS)和无进展生存期(progressionfree survival,PFS)的影响,并用Log-rank检验比较生存曲线,运用Cox回归模型多因素分析糖尿病与NMIBC之间的关系,并评估影响其RFS和PFS的预后因素。结果:200例NMIBC患者平均随访14.2(4~40)个月,糖尿病组和非糖尿病组肿瘤复发率分别为34.1%(14/41)和28.3%(45/159),中位无复发生存时间分别为12.0个月(4~38个月)和14.7个月(5~40个月),肿瘤进展率分别为9.8%(4/41)和6.9%(11/159),糖尿病组较非糖尿病组肿瘤复发率高(χ2=4.875,P=0.027),无复发生存时间短(P0.001),而进展率的差异无统计学意义(P=0.770)。Cox多因素生存分析显示糖尿病(P0.001,HR=2.731)、肿瘤大小(P=0.012,HR=2.344)和NMIBC更高的复发风险相关,而灌注药物(P0.001,HR=0.110)会显著降低NMIBC的复发风险。结论:糖尿病是NMIBC患者RFS的独立危险因素,患有糖尿病的NMBIC患者术后复发率更高。     

血浆过氧化物还原酶2与维持性血液透析患者预后的相关性研究

目的探究血浆过氧化物还原酶2(PRDX2)与维持性血液透析(MHD)患者预后的相关性。 方法选取2018年3月至6月于河北北方学院附属第一医院就诊的134例MHD患者(MHD组)和100例健康体检者(对照组);根据随访期间是否发生终点事件(主要不良心血管事件,MACE),将MHD患者分为非MACE组和MACE组。用酶联免疫吸附法检测血浆PRDX2水平,用COX回归分析MHD患者发生MACE的风险因素,用受试者工作特征(ROC)曲线评价PRDX2预测MHD患者发生MACE的价值,用限制性立方样条拟合COX回归方法分析PRDX2与MHD患者发生MACE的剂量-效应关系。 结果MHD组的血浆PRDX2水平低于对照组(P<0.05)。MACE组有糖尿病史比例和超敏C反应蛋白水平均高于非MACE组,血红蛋白和血浆白蛋白水平均低于非MACE组(P<0.05)。MACE组的治疗前和治疗后的血浆PRDX2水平均低于非MACE组;MACE组和非MACE组的治疗后血浆PRDX2水平均较治疗前升高;MACE组治疗后的血浆PRDX2水平升高程度高于非MACE组(均P<0.05)。治疗前PRDX2预测MHD患者发生MACE的ROC曲线下面积大于治疗后面积和治疗前后面积的差值(P<0.05)。COX回归分析结果显示高血红蛋白(HR＝0.975,95%CI：0.959~0.992,P＝0.004)、高血浆白蛋白(HR＝0.928,95%CI：0.888~0.971,P＝0.001)和治疗前的高PRDX2水平(HR＝0.827,95%CI：0.743~0.920,P<0.001)是MHD患者发生MACE的独立保护因素。限制性立方样条拟合COX回归分析显示,治疗前PRDX2水平与MHD患者发生MACE呈非线性关系。 结论治疗前的血浆PRDX2水平与MHD患者发生MACE有关,其水平低提示MHD患者发生MACE风险高。     

miR-1256在结直肠癌中的表达及预后相关性研究

目的:探讨m i R-1256在结直肠癌(CRC)中的表达及预测远期生存预后的临床价值。方法:采用实时荧光定量PCR检测178例CRC患者的癌组织及癌旁组织中的mi R-1256的表达量,通过Kaplan-Me ie r生存曲线分析m i R-1256表达水平不同的CRC患者的无进展生存期(PFS)和总体生存期(OS)的差异,并通过单因素和多因素Cox回归分析确定影响PFS和OS的独立危险因素。结果:CRC患者的癌组织中mi R-1256表达量显著低于癌旁组织(P0.001)。与mi R-1256高表达患者相比,m i R-1256低表达患者的TNMⅢ～Ⅳ期比例更高(24.4%vs 54.5%,P0.001)、淋巴结转移阳性率更高(24.4%vs 58.0%,P0.001)、PFS和OS均明显缩短(均P0.001)。多因素Cox回归分析显示TNMⅢ～Ⅳ期(HR=4.983,95%CI:3.484～6.588,P0.001)、淋巴结转移阳性(HR=2.031,95%CI:1.204～3.491,P=0.009)和m i R-1256低表达(HR=3.281,95%CI:2.256～4.982,P0.001)是影响CRC患者PFS缩短的独立危险因素;TNMⅢ～Ⅳ期(HR=4.203,95%CI:2.301～6.874,P0.001)、淋巴结转移阳性(HR=1.784,95%CI:1.243～3.886,P=0.047)和mi R-1256低表达(HR=2.903,95%CI:1.835～5.218,P0.001)也是影响CRC患者OS缩短的独立危险因素。结论:CRC癌组织中m i R-1256的降低与CRC肿瘤进展相关,也是预测CRC患者远期生存预后降低的重要生物标志物。     

Survival of analysis of older patients with external iliac vein tunneled cuffed catheters on maintenance hemodialysis

Objective To investigate the survival of older patients with iliac vein tunneled cuffed catheters on maintenance hemodialysis. Methods A total of 70 older patients with external iliac vein tunneled cuffed catheters on maintenace hemodialysis were included in this study, there were 94 patients with internal jugular vein tunneled cuffed catheters as control group. The baseline anthropometric and 1aboratory parameters were measured. The catheter dysfunction and catheter related complications were documented. Results There were lower survival rate and catheter survival in the external iliac vein group compared with internal jugular vein group（χ2=13.714, P＜0.01;χ2=13.093, P＜0.01）. Compared with internal jugular vein group, there was lower rate of catheter infection in external iliac vein group(χ2=9.416, P＜0.01); In addition, there were higher rate of cardiovascular disease(CVD) events and catheter dysfunction among patients in external iliac vein group (χ2=7.492, P＜0.01;χ2=5.912, P＜0.05). Furthermore, the incidence of catheter dysfunction and cardiovascular disease events were the independent risk factors of mortality for older patients with iliac vein tunneled cuffed catheters on maintenance hemodialysis by Cox regression model. Conclusions Patients with iliac vein tunneled cuffed catheters have a shorter survival time. Those with catheter dysfunction or cardiovascular disease events are in higher risk of mortality．     

Risk factor analysis of pneumonia in maintenance hemodialysis patients

Objective To investigate the risk factors of pneumonia in maintenance hemodialysis (MHD) patients. Methods The clinical data of patients undergoing dialysis longer than three months at the Hemodialysis Center of West China Hospital of Sichuan University from July 2013 to July 2018 were retrospectively analyzed. The patients were divided into pneumonia group and non- pneumonia group. Follow-up time started from admission to the beginning of hemodialysis. All patients were followed until the patient died, or withdrawn from hemodialysis, or transferred to another center, or until the study deadline (April 2019). Baseline clinical data were compared between the two groups, and the differences in clinical data between the pneumonia group and the baseline were also analyzed. Risk factors for pneumonia in hemodialysis patients was analyzed by binary logistic regression. Kaplan-Meier curve was used to compare the survival prognosis of the two groups, and the Log-rank method was used for significant test. A multivariate Cox proportional hazard model was used to analyze risk factors for MHD patients' death. Results (1) A total of 311 patients were enrolled in the study, in which 178 (57.2%) of the patients were male, and 75(24.1%) of the patients had pneumonia. Compared with non-pneumonia group, the pneumonia group patients were older (P=0.002), had higher level of white blood cells (P=0.001) and lower level of serum creatinine (P=0.003), albumin (P=0.001), and serum magnesium (P=0.039). There were also statistically significant differences between the two groups in the proportion of females and underlying diseases (all P＜0.05). (2) The time of pneumonia occurred from the initial time of dialysis was (10.69±9.82) months. Compared with baseline values, decreased hemoglobin and albumin level were found (both P＜0.01). (3) Logistic regression analysis showed male patients had lower risk of pneumonia than female patients (OR=0.438, 95%CI 0.242-0.795, P=0.007). For every 1 g/L increase in albumin, the risk of pneumonia was reduced by 6.4% (OR=0.936, 95%CI 0.885-0.991, P=0.022). Kaplan-Meier survival curve analysis showed that the difference in 5-year cumulative survival rate between pneumonia group and non-pneumonia group was statistically significant ( 60.6% vs 84.4%, χ2=16.647, P＜0.001). (4) Multivariate Cox regression analysis showed that long dialysis time (HR=0.870, 95%CI 0.832-0.909, P＜0.001) and high serum albumin level (HR=0.898, 95%CI 0.845-0.955, P=0.001) were protective factors in patients with MHD. Pneumonia (HR=3.008, 95%CI 1.423-6.359, P=0.004) was an independent risk factor for death in MHD patients. Conclusions Hemoglobin and albumin level are reduced in MHD patients with pneumonia. Low albumin level is a risk factor for pneumonia in patients. MHD patients with pneumonia have a lower survival time than those without pneumonia.     

Effects of abdominal aortic calcification progression on outcomes in maintenance hemodialysis patients

Objective To investigate the effects of abdominal aortic calcification (AAC) progression on outcomes in maintenance hemodialysis (MHD) patients. Methods Patients who were on MHD between Jun. 2014 and Oct. 2014 in the dialysis center of the Second Hospital of Tianjin Medical University and finished the AAC examination at baseline and two years later were included prospectively. The progression of AAC by AAC score (AACs) at baseline and two years later was evaluated. According to the change of AACs, the patients were divided into rapid AAC progression group and non-rapid AAC progression group. The effect of AAC progression on outcomes in MHD patients in the follow-up period was investigated. Kaplan-Meier analysis was used to compare their survival rates. Multivariable Cox regression model was used to determine the risk factors of all-cause mortality, cardiovascular mortality and cardiovascular events. Results A total of 111 MHD patients were included, including 51 males and 60 females, aged (52.24±12.69) years. Baseline AAC prevalence was 45.9% (51/111), and median AACs was 0 (0, 5); After 2 years, the prevalence of AAC was 78.4% (87/111), and the median AACs was 6 (2, 11). There were 54 cases in the AAC rapid progression group (AACs change value＞2) and 57 cases in the non-rapid AAC progression group (AACs change value≤2). The median follow-up duration was 27.9(27.1, 28.0) months. Kaplan-Meier analysis showed that patients in rapid AAC progression group had a higher risk of mortality as compared to patients in non-rapid AAC progression group (Log-rank χ2=5.695, P=0.017). Multivariate Cox regression analysis demonstrated that high baseline AACs (HR=1.135, 95%CI 1.001-1.286, P=0.048), hypoalbuminemia (HR=0.789, 95%CI 0.640-0.972, P=0.026) were independent risk factors for all-cause mortality in MHD patients. High baseline AACs (HR=1.187, 95%CI 1.038-1.356, P=0.012), low spKt/V (HR=0.103, 95%CI 0.013-0.801, P=0.030) were independent risk factors for cardiovascular mortality in MHD patients. Low spKt/V (HR=0.018, 95%CI 0.003-0.115, P＜0.001), hypoalbuminemia (HR=0.736, 95%CI 0.608-0.890, P=0.002) were independent risk factors for cardiovascular events in MHD patients. Conclusions Abdominal aortic calcification progression may increase the risk of cardiovascular events and death in MHD patients. Severity of AAC, adequacy of dialysis, and nutritional status are predictors of outcomes in MHD patients.     

Investigation of vascular access in maintenance hemodialysis patients in Shanxi province

Objective To understand the current situation of vascular access selection in maintenance hemodialysis (MHD) patients in Shanxi Province, and analyze the factors affecting vascular access selection and risk factors of death in MHD patients. Methods MHD patients with clear vascular access information in Shanxi Province from January 2014 to December 2018 were enrolled in this study. The clinical data of patients were collected. The vascular access information of the selected candidates was clear. Multivariate logistic regression equation method was used to analyze the influencing factors of vascular access and the risk factors of death in MHD patients. Results Among the 10.236 patients with MHD, 9.130 patients (89.2%) selected autologous arteriovenous fistula (AVF) as vascular access, and 5.138 patients (50.2%) chose tunnel-free and non-polyester sheath central venous catheter (NCC) for the first dialysis. Multivariate logistic regression analysis showed that the primary disease of diabetic nephropathy (OR=0.517, 95%CI 0.281-0.796, P＜0.001) and dialysis age＜1 year (OR=0.483, 95%CI 0.219-0.811, P＜0.001) were the influencing factors of patients with MHD who did not to choose AVF. Primary disease of diabetic nephropathy (OR=2.242, 95% CI 1.816-2.828, P＜0.001), and using of central vein catheter (OR=1.785, 95% CI 1.237-2.579, P＜0.001) were independent risk factors of death in MHD patients. Conclusions AVF is the first choice for MHD patients in Shanxi Province. There is higher proportion of the use of NCC as the first dialysis vascular access. Primary disease of diabetic nephropathy and dialysis age＜1 year are the influencing factors for MHD patients not to choose AVF. Primary disease of diabetic nephropathy and use of central vein catheter may increase the risk of death in MHD patients.     

Effects of serum magnesium level on mortality in maintenance hemodialysis patients

Objective To investigate the effects of serum magnesium level on all-cause mortality and cardiovascular and cerebrovascular diseases mortality in maintenance hemodialysis (MHD) patients. Methods Clinical data of MHD patients in Shaoxing People's Hospital from June 1, 2016 to June 30, 2018 were collected retrospectively. The patients were divided into low magnesium group (serum magnesium≤0.96 mmol/L), medium magnesium group (serum magnesium 0.97-1.07 mmol/L) and high magnesium group (serum magnesium≥1.08 mmol/L) according to the tertile of mean serum magnesium level. The differences of clinical data and laboratory results were compared among the three groups. Kaplan-Meier method was used to draw the survival curves, and log-rank test was used to compare the survival rate differences. Multivariate Cox regression was used to analyze the relationship between serum magnesium and all-cause mortality and cardiovascular and cerebrovascular diseases mortality in MHD patients. Results A total of 332 patients [194 males (58.4%)] were included in this study, with a median age of 63(51, 72) years and a median follow-up time of 36(20, 45) months. Kaplan-Meier survival analysis showed that the all-cause survival rate and cardiovascular and cerebrovascular diseases survival rate in the low magnesium group were lower than those in the medium magnesium group and the high magnesium group (Log-rank χ2=36.286, P＜0.001; Log-rank χ2=20.145, P＜0.001; respectively). After adjusting for multiple confounding factors, the results of multivariate Cox regression analysis suggested that low serum magnesium was an independent risk factor for all-cause death and cardiovascular and cerebrovascular diseases death in MHD patients. The risk of all-cause death and cardiovascular and cerebrovascular diseases death in the low magnesium group were significantly higher than those in the high magnesium group (HR=2.925, 95%CI 1.352-6.330, P=0.006; HR=3.821, 95% CI 1.394-10.473, P=0.009; respectively). Conclusions Hypomagnesemia may be an independent risk factor for all-cause death and cardiovascular and cerebrovascular diseases death in MHD patients. Low serum magnesium level increases the risk of all-cause death and cardiovascular and cerebrovascular diseases in MHD patients.     

维持性血液透析患者血氨基末端脑钠肽前体水平与肾性贫血的相关性

目的探讨维持性血液透析(MHD)患者发生肾性贫血的危险因素,分析其与血氨基末端脑钠肽前体(NT⁃proBNP)的相关关系。方法选取2018年8月至2018年11月期间在复旦大学附属华山医院接受MHD 3个月以上、病情稳定的患者为研究对象。按照血红蛋白(Hb)水平分为贫血组和非贫血组。回顾性收集患者一般资料、观察期内实验室检查及透析相关资料。Pearson相关分析法分析贫血指标与透析相关指标、血NT⁃proBNP水平的相关性;逐步多元线性回归法分析MHD患者发生贫血的危险因素。结果共160例MHD患者入选本研究,年龄(63.11±11.35)岁,男79例(49.4%),女81例(50.6%)。患者透析龄(118.01±82.32)个月,血红蛋白(110.09±13.48)g/L,NT⁃proBNP水平中位数为3985 ng/L。贫血组73例(45.6%),非贫血组87例(54.4%),贫血组血NT⁃proBNP水平显著高于非贫血组(t=-3.714,P<0.001)。MHD患者血红蛋白水平与每周透析时间(r=0.228)和血白蛋白(r=0.349)呈正相关,与血NT⁃proBNP水平呈负相关(r=-0.318);血细胞比容与每周透析时间(r=0.283)、血清钙(r=0.317)、血磷(r=0.264)、白蛋白(r=0.513)呈正相关(均P<0.05)。逐步多元线性回归分析结果显示,低血白蛋白、高NT⁃proBNP水平是MHD患者发生肾性贫血的独立危险因素。结论MHD患者NT⁃proBNP水平升高与血红蛋白水平降低相关,低血白蛋白、高NT⁃proBNP是MHD患者发生贫血的危险因素。提示肾性贫血的治疗需要考虑改善营养不良和高容量等因素。     

Incidence of cognitive impairment and risk factors associated with prognosis in maintenance hemodialysis patients

Objective To investigate the incidence and prognosis of cognitive impairment and to find out the risk factors associated with the outcome for better understanding and preventing cognitive impairment in maintenance hemodialysis (MHD) patients. Methods The patients who met the criteria as below: MHD patients (≥3 months) in Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2000 to July 2014, ≥18 years old were enrolled and could carry on the montreal cognitive assessment (MoCA) of voluntary cooperation. According to the score of MoCA, all enrolled patients were divided into two groups: cognitive impairment (MoCA＜26) group and non-cognitive impairment (MoCA≥26) group. The follow-up period was 3 years. There were 130 males, and the incidence, demography data, medical history, hemodialysis data, laboratory examination and prognosis of cognitive impairment in hemodialysis patients were prospectively compared and analyzed. Logistic regression analysis was used to investigate the risk factors of cognitive impairment. Kaplan-Meier survival curve and Cox regression model were used for prognostic analysis. Results A total of 219 MHD patients were enrolled. The incidence of cognitive impairment in MHD patients was 51.6%. There were 130 males, and the ratio of male to female was 1.46∶1. Age was (60.07±12.44) years old and dialysis vintage was (100.79±70.23) months. Compared with non-cognitive impairment group (n=106), patients in cognitive impairment group (n=113) were older, and had higher proportion of education status＜12 years, history of diabetes and anuria (all P＜0.05); however, the post-dialysis systolic pressure, pre-dialysis diastolic pressure, post-dialysis diastolic pressure, platelet and spKt/V were lower (all P＜0.05). Multivariate logistic regression analysis showed that education status＜12 years (OR=3.428, 95%CI 1.919-6.125, P＜0.001), post-dialysis diastolic pressure＜73 mmHg (OR=2.234, 95%CI 1.253-3.984, P=0.006) and spKt/V＜1.72(OR=1.982, 95%CI 1.102-3.564, P=0.022) were the independent risk factors for cognitive impairment in MHD patients. The Kaplan-Meier survival curve analysis showed that the survival rate of patients with cognitive impairment was lower than that of non-cognitive impairment group in MHD patients during 3 years follow-up (χ2=3.977, P=0.046). Multivariate Cox regression analysis showed that cognitive impairment was an independent risk factor for death in MHD patients (RR=2.661, 95%CI 0.967-7.321, P=0.058). Conclusions Cognitive impairment is one of the common complications and an independent risk factor for death in MHD patients. The mortality is high in patients who suffer cognitive impairment. Education status ＜12 years, post-dialysis diastolic pressure＜73 mmHg and spKt/V＜1.72 are the independent risk factors for cognitive impairment in MHD patients.     

Effect of serum uric acid level on prognosis in maintenance hemodialysis patients

Objective To analyze the relationship between serum uric acid (SUA) level and clinical indicators in maintenance hemodialysis (MHD) patients, and explore its influence on all-cause mortality and cardiovascular mortality. Methods This study was a retrospective cohort study. Patients who received MHD from the blood purification center of the Third Affiliated Hospital of Sun Yat-sen University from January 1, 2011 to December 30, 2015 were enrolled in the queue. They were divided into 3 groups according to the first and third quantile of the SUA level quartiles, and the baseline data of clinical and laboratory examinations were compared. The correlation between SUA level and clinical indicators was analyzed by Pearson correlation coefficient. Kaplan-Meier method and Cox proportional hazard regression model were used to examine the association between SUA and all-cause mortality and cardiovascular mortality in MHD patients. Results A total of 201 patients were enrolled in the study. The age of the patients was (56.9±16.7) years and the baseline SUA level was (531.1±137.9) μmol/L. Patients were divided into 3 groups with the first quantile (442 μmol/L) and the third quantile (620 μmol/L) of the SUA quartiles as the boundary points: group 1 (SUA＜442 μmol/L, n=52), group 2 (SUA 442-620 μmol/L, n=101) and group 3 (SUA＞620 μmol/L, n=48). The results showed that the patients in group 1 were older and had more proportion of patients with diabetes mellitus and cardiovascular diseases than those in group 3 (all P＜0.05). Compared to group 3, the serum albumin, serum phosphorus and serum creatinine were lower in group 1, while the hypersensitive C-reactive protein was higher (all P＜0.05). Pearson correlation analysis showed that SUA level was positively correlated with albumin (r=0.135, P=0.047), blood phosphorus (r=0.269, P＜0.001) and serum creatinine (r=0.333, P＜0.001), and negatively correlated with hypersensitive C-reactive protein (r=-0.216, P=0.002). After a median follow-up of 49.8 months, 66(32.8%) all-cause deaths and 32(15.9%) cardiovascular deaths were recorded. Kaplan-Meier method showed that with the decrease of SUA, all-cause mortality (Log-rank χ2=18.27, P＜0.001) and cardiovascular mortality (Log-rank χ2=15.04, P=0.001) increased. After adjusting for age, gender, comorbidity and other factors using the Cox proportional hazards model, the all-cause mortality and cardiovascular mortality decreased by 20.1% (HR=0.799, 95% CI 0.651-0.980, P=0.031) and 29.6% (HR=0.704, 95% CI 0.524-0.946, P=0.020) for each 100 μmol/L increase in baseline SUA. Compared to group 1, all-cause mortality (HR=0.332, 95%CI 0.142-0.774, P=0.011) and cardiovascular mortality (HR=0.140, 95%CI 0.030-0.657, P=0.013) were lower in the group 3. Conclusion Low SUA level increases the risk of all-cause mortality and cardiovascular mortality in MHD patients.     

Assessment of frailty and its influence factors in maintenance hemodialysis patients

Objective To investigate the frailty in maintenance hemodialysis (MHD) patients and its influence factors. Methods A total of 127 adults undergoing hemodialysis from January 2015 and January 2016 in our center were recruited. Their clinical data and blood biochemical data were collected. Frailty was assessed using Fried's Frailty Phenotype. Quantification of coronary artery calcification (CACs) was determined by multi-slice spiral computed tomography (MSCT). According to the frailty scores, patients were divided into non-frailty, pro-frailty and frailty group. Their in clinical and biochemical index as well as CACs were compared. The correlations of frailty scores with above index were assessed by Spearman's correlation. Multiple logistic regression analysis was applied to evaluate the effect factors of frailty on MHD patients. Results Among 127 selected patients, 46(36.22%) patients without frailty, 45(35.43%) patients with pro-frailty, and 36(28.35%) patients with frailty. The age, diabetes, haemoglobin, albumin, pre-albumin, C-reactive protein, fibroblast growth factor 23 (FGF23), CACs and left ventricular end-diastolic dimension (LVEDD) of the 3 groups had statistical differences (all P＜0.05). The degrees of calcification among 3 groups were also different statistically (F=31.769, P＜0.001). In patients with MHD, frailty was positively correlated with age (r=0.545, P＜0.001), diabetes (r=0.236, P=0.008), C-reactive protein (r=0.245, P=0.006), FGF23 (r=0.189, P=0.034) and CACs (r=0.396, P＜0.001), while negatively correlated with haemoglobin (r=-0.257, P=0.004), albumin (r=-0.380, P＜0.001), pre-albumin (r=-0.313, P＜0.001). Age (OR=1.076), C-reactive protein (OR=1.176), albumin (OR=0.796) and artery calcification (OR=2.465) were independent influence factors for frailty in MHD patients (all P＜0.05). Conclusions The prevalence of frailty is high among MHD patients. Frailty is associated with age, C-reactive protein, albumin and artery calcification in MHD patients.