维持性血液透析患者住院率及生存率分析

目的：了解我中心维持性血液透析（MHD）患者的住院率、死亡率及其原因,为提高患者生存率提供依据。方法：回顾性分析2010年5月~2013年5月我中心MHD患者的住院率、死亡率及其原因,以及治疗前后各项指标的变化。结果：我中心年住院率为595住院次/1 000病人年,主要原因有心脑血管事件（13.0%）、血管通路问题（11.5%）、感染（9.9%）等。死亡率为13人/1 000病人年,主要死亡原因为心脑血管事件（50%）、感染（25%）等。经治疗后所有患者KT/V、Hb、血清钙水平较治疗前均有明显升高（P〈0.05）。结论：心脑血管事件、血管通路、感染是我中心MHD患者住院的主要因素,其中心脑血管事件和感染是死亡的主要原因。     

血红蛋白变异率与血液透析患者通路失功相关性的临床研究

目的:维持性血液透析患者血红蛋白变异率和血液透析通路失功发生的关系。方法:收集随访从2020年01月—2020年12月在长海医院肾内科血液透析中心维持性血液透析患者临床资料,记录血管通路失功发生率,分析血红蛋白变异率与血管通路失功的关联性。结果:在完成随访的285例患者中,48例患者出现血透通路失功,237例患者血管通路正常。对两组血透患者的基线数据进行曼-惠特尼检验,血红蛋白变异率(P=0.041)、肌酐(P=0.005)和肾小球滤过率(P=0.06)差异有统计学意义。通过患者资料与血管通路情况的斯皮尔曼相关性分析,发现血红蛋白变异率(P=0.041)、肌酐(P=0.004)和肾小球滤过率(P=0.006)与血管通路失功相关。回归分析表明,血管通路失功与血红蛋白变异率(P=0.002)之间存在显着相关性。结论:血透患者高血红蛋白变异率与血透通路失功存在一定的相关性。     

维持性血液透析患者医院感染临床分析

血液透析患者常存在免疫功能紊乱、抵抗力差、易并发感染,且感染已成为血透患者主要的死亡原因之一.医院感染近年来已引起国内外医学界的极大重视,血透患者是医院感染的高危人群,因而探讨血透患者医院感染的特点,从而有效防止医院感染尤为重要.我们对近3年132例住院维持性血透患者发生的医院感染进行回顾性分析.     

血红蛋白浓度对维持性血液透析患者再入院的影响

目的:探讨血红蛋白浓度对维持性血液透析患者发生再入院的影响.方法:回顾性分析了2000年1月～2005年12月期间在我院首次诊断CKD 5期并开始进入维持性血液透析的两次或两次以上入院的患者,并选取同期未再入院的维持性血液透析患者作为对照组,记录患者进入血透时的年龄、性别、ESRD的病因,血红蛋白(Hb)的浓度,发生再入院时的间隔时间、原因,以及再入院的Hb浓度.结果:维持性血液透析发生再入院的患者50例,男27例,女23例;年龄35岁～84岁,平均(65.81±11.83)岁;初次诊断ESRD时患者Hb的浓度为(71.83±16.74)g/L.对照组50例,男29例,女21例;年龄37岁～83岁,平均(63.52±13.21)岁;进入血透时Hb浓度为(69.29±18.86)g/L.分析再入院时的时间间隔为(11.76±7.81)月,再入院的原因为心功能不全,感染,脑梗死、脑出血、心绞痛、消化道出血、动静脉内瘘处阻塞.再入院时患者的Hb浓度为(75.83±17.39)g/L,对照组为(90.64±15.32)g/L.经统计学分析提示,Hb每下降1 g/L,患者发生再入院的相对危险性就增加5%.结论:贫血的存在影响维持性血液透析患者再入院的频率和时间间隔.临床应积极纠正血透患者的贫血程度.     

血红蛋白水平对维持性血液透析患者心血管事件发生的影响

目的:观察维持性血液透析患者血红蛋白水平对心血管事件发生的影响。方法:选取符合治疗时间≥3个月、规律性透析、治疗规范、依从性好、定期监测血指标患者198例。每月监测患者血常规,每3个月监测患者血脂、钙、磷等指标。随访1年,记录患者心血管事件和因心血管事件死亡情况。分析不同血红蛋白水平对心血管事件的影响。结果:低血红蛋白组(Hb<110g/L)心血管事件发病率最高,为62.0%(62/100),目标血红蛋白组(110g/L≤Hb≤120g/L)最低,为30.2%(16/53),两组比较P<0.05。高血红蛋白组(Hb>120g/L)发病率为55.6%(25/45),与目标血红蛋白组比较P<0.05。因心血管事件病死率低血红蛋白组最高,为19.0%(19/100),目标血红蛋白组最低,为3.8%(2/53),两组比较P<0.05。高血红蛋白组病死率为14.6%(8/45),与目标血红蛋白组比较P<0.05。结论:血红蛋白水平影响心血管事件的发生,低于或高于目标血红蛋白水平均有较高的心血管事件发病率。     

雌激素与维持性血液透析妇女骨质疏松的关系

在维持性血液透析女性患者中有提前闭经、低雌激素血症现象,低雌激素血症可通过雌激素受体、细胞因子、细胞核因子κB受体活化因子-护骨素系统、骨细胞凋亡、甲状旁腺激素、甲状旁腺激素相关肽多个水平影响该类患者骨质疏松的发生.     

雌激素与维持性血液透析妇女骨质疏松的关系

在维持性血液透析女性患者中有提前闭经、低雌激素血症现象,低雌激素血症可通过雌激素受体、细胞因子、细胞核因子κB受体活化因子-护骨素系统、骨细胞凋亡、甲状旁腺激素、甲状旁腺激素相关肽多个水平影响该类患者骨质疏松的发生.     

雌激素与维持性血液透析妇女骨质疏松的关系

在维持性血液透析女性患者中有提前闭经、低雌激素血症现象,低雌激素血症可通过雌激素受体、细胞因子、细胞核因子κB受体活化因子-护骨素系统、骨细胞凋亡、甲状旁腺激素、甲状旁腺激素相关肽多个水平影响该类患者骨质疏松的发生.     

雌激素与维持性血液透析妇女骨质疏松的关系

在维持性血液透析女性患者中有提前闭经、低雌激素血症现象,低雌激素血症可通过雌激素受体、细胞因子、细胞核因子κB受体活化因子-护骨素系统、骨细胞凋亡、甲状旁腺激素、甲状旁腺激素相关肽多个水平影响该类患者骨质疏松的发生.     

雌激素与维持性血液透析妇女骨质疏松的关系

在维持性血液透析女性患者中有提前闭经、低雌激素血症现象,低雌激素血症可通过雌激素受体、细胞因子、细胞核因子κB受体活化因子-护骨素系统、骨细胞凋亡、甲状旁腺激素、甲状旁腺激素相关肽多个水平影响该类患者骨质疏松的发生.     

The Relation Between Variability of Intact Parathyroid Hormone,Calcium, and Cardiac Mortality in Hemodialysis Patients

Chronic kidney disease‐mineral and bone disorder (CKD‐BMD) is a condition known to be associated with cardiovascular disease and mortality in hemodialysis (HD) patients. The relation between calcium (Ca), phosphorus (P), and intact parathyroid hormone (iPTH) variability in HD patients and cardiac mortality is unknown. The purpose of this study was to assess the relation between variability in these parameters and cardiac mortality. Baseline demographic and biochemical parameters of 218 HD patients together with Ca values corrected with albumin and P values measured on a monthly basis and iPTH levels measured at 3‐monthly intervals were recorded over 2 years. Standard deviation (SD) and smoothness index (SI) for each parameter were calculated to assess Ca, P, and iPTH variability. The relations between all parameters and cardiac mortality were then analyzed. Cardiac mortality was observed in 38 patients in the 2‐year study period. Nonsurviving patients' ages, systolic and diastolic blood pressure (DBP), high sensitivity C‐reactive protein (HsCRP) levels, mean iPTH, and SD iPTH were significantly higher than those of surviving patients, while albumin levels, SI iPTH and SI Ca were significantly lower. Age, low albumin, high DBP, SI iPTH, and SI Ca were identified as independent predictors of cardiac mortality at multivariate analysis. Our study shows that Ca and iPTH variability affect cardiac mortality independently of mean and baseline values. When supported by further studies, the relation between Ca and iPTH variability and cardiac mortality in HD patients can lead to a new perspective in terms of prognosis and treatment planning.     

比索洛尔对维持性血液透析患者高血压及心率变异性的影响

目的:观察比索洛尔对维持性血液透析患者高血压及心率变异性的疗效。方法:选取2010年6月～12月在我科行维持性血液透析患者33例,在常规高血压治疗基础上加用比索洛尔5～10mg/d,观察时间为6个月,治疗前和治疗6月后检测动态心电图和生化指标。结果:比索洛尔能明显降低维持性血液透析患者的血压(P<0.05),改善心率变异性(P<0.05),减少心律失常的发生率(P<0.05),而对血清总胆固醇、尿酸、血糖没有明显影响(P>0.05)。结论:比索洛尔能改善维持性血液透析患者的心率变异性,是安全有效的治疗措施。     

维持性血透患者长期生存率与血清脂联素的关系

目的：探讨维持性血透患者长期生存率与血清脂联素的关系。方法：选择血液净化中心规律血液透析超过6个月的患者81例,随访16个月。分析其长期存活率,改良定量SGA评估法评估血透患者营养状况,测定体重指数、血红蛋白、胆固醇、三酰甘油、透析充分性,采用ELISA法测定血清脂联素水平,评估血清脂联素与血透患者长期生存率之间的关系。结果：维持性血透患者1年、2年、3年、5年、10年存活率分别为100%、90.12%、75.31%、38.27%、6.17%。Cox回归模型发现,年龄（r=1.088,P〈0.05）、ADPN（r=1.671,P〈0.01）是导致患者死亡的危险因素。透析开始年龄≤60岁组生存率高于〉60岁组（P〈0.05）。结论：血透开始年龄、血清脂联素水平是影响维持性血透患者生存率的危险因素。     

Association of Reduction in Bone Mineral Density with Mortality in Male Hemodialysis Patients

In the present study we examined the relationship of bone mineral density (BMD) reduction with increased mortality in hemodialysis patients. A single-center prospective observational study was conducted on 269 male hemodialysis patients. The BMD in the distal third of the radius (DR1/3) and in the ultradistal radius (UR), which are enriched with cortical and cancellous bone, respectively, was measured twice using dual-energy X-ray absorptiometry (DXA) with a 1-year interval. Subjects were divided into two groups based on the presence or absence of BMD reduction. Survival was followed for 61.0 months, after which time 104 patients (39%) had died. A significant BMD reduction at the UR and DR1/3 occurred in 182 (68%) and 195 (72%) patients, respectively. Patients with BMD reduction in the UR, in contrast to the DR1/3, had a significantly lower survival rate than those without BMD reduction (P = 0.01). In Cox regression analysis, the rate of BMD change at the UR, in addition to patient age, diabetes mellitus, and serum albumin, emerged as an independent predictor for increased mortality (HR = 0.970, 95% CI 0.945–0.996). Our results suggest that BMD reduction at the UR might be a clinically relevant marker that predicts an increased risk of mortality in male hemodialysis patients.     

Hemoglobin Variability Does Not Predict Mortality in European Hemodialysis Patients

Patients with CKD exhibit significant within-patient hemoglobin (Hb) level variability, especially with the use of erythropoiesis stimulating agents (ESAs) and iron. Analyses of dialysis cohorts in the United States produced conflicting results regarding the association of Hb variability with patient outcomes. Here, we determined Hb variability in 5037 European hemodialysis (HD) patients treated over 2 years to identify predictors of high variability and to evaluate its association with all-cause and cardiovascular disease (CVD) mortality. We assessed Hb variability with various methods using SD, residual SD, time-in-target (11.0 to 12.5 g/dl), fluctuation across thresholds, and area under the curve (AUC). Hb variability was significantly greater among incident patients than prevalent patients. Compared with previously described cohorts in the United States, residual SD was similar but fluctuations above target were less frequent. Using logistic regression, age, body mass index, CVD history, dialysis vintage, serum albumin, Hb, angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) use, ESA use, dialysis access type, dialysis access change, and hospitalizations were significant predictors of high variability. Multivariable adjusted Cox regression showed that SD, residual SD, time-in-target, and AUC did not predict all-cause or CVD mortality during a median follow-up of 12.4 months (IQR: 7.7 to 17.4). However, patients with consistently low levels of Hb (<11 g/dl) and those who fluctuated between the target range and <11 g/dl had increased risks for death (RR 2.34; 95% CI: 1.24 to 4.41 and RR 1.74; 95% CI: 1.00 to 3.04, respectively). In conclusion, although Hb variability is common in European HD patients, it does not independently predict mortality.The optimal target hemoglobin (Hb) concentration in patients with chronic kidney disease (CKD) remains a matter of considerable uncertainty. Randomized controlled trials have demonstrated that aiming for a “normal” Hb concentration does not improve outcomes but may increase the risk of cardiovascular morbidity and/or mortality.^1–4 These results suggest the optimal Hb may differ between the physiologic regulation of red cell formation and the therapeutic correction of anemia using erythropoiesis stimulating agents (ESAs) in CKD patients.An apparent difference between CKD patients receiving ESAs and normal individuals is Hb variability over time. A potential challenge in determining the clinical relevance of Hb fluctuations lies in the method used to assess Hb variability. Currently available metrics of variability mostly reflect a single aspect of variability (e.g., magnitude, frequency, or duration)^5,6 and fail to simultaneously capture all components. Within-patient SD is the simplest measure of Hb variability, but it fails to discern patterns or directionality and cannot account for overall trends. Assessing variation derived from a regression line of Hb values (i.e., “residual SD”) can account for overall trend but does not reflect patterns of variability.⁷ The “time-in-target” is another easy-to-calculate measure, but as with SD and residual SD, it fails to account for variability patterns. Assessing Hb variability using the categories below, within or above a target range, has the advantage of describing the initial range of Hb measures, direction of change, and amplitude of change^8,9; however, further statistical analysis becomes limited because it fails to provide a quantitative measure.To date, large population-based studies on Hb variability have been based on hemodialysis (HD) patient populations in the United States.^7–11 Extrapolation of these data to European populations may not be adequate because of differences in patient characteristics and patterns of care, including higher ESA doses in the United States.¹²The Analyzing data, Recognizing excellence, Optimizing outcomes (ARO) CKD research initiative aims to identify risk factors and opportunities for intervention in a large European dialysis cohort using a common database of patients from more than 150 Fresenius Medical Care dialysis centers in eastern and western Europe (EU-FME).¹³ The aim of this study was to characterize Hb variability in these patients using different measures, to identify predictors of Hb variability, and to evaluate the association between Hb variability and mortality.     

Association Among Serum Fetuin-A Level, Coronary Artery Calcification, and Bone Mineral Densitometry in Maintenance Hemodialysis Patients

Patients with end‐stage renal disease have a very high prevalance and extent of arterial calcification. A number of studies suggest that similar pathophysiologic mechanisms are responsible for development and progression of calcification of atherosclerotic plaque and bone formation. Fetuin‐A is a potent calcification inhibitor and is expressed in bone, with not‐yet well‐defined functions. The aim of this study was to investigate the relation between bone mineral densitometry parameters, coronary artery calcification, and serum fetuin‐A levels. In a cross‐sectional design, we included 72 maintenance hemodialysis (HD) patients and 30 age‐ and gender‐ matched healthy controls. Serum fetuin‐A levels were studied both in maintenance HD patients and healthy controls. Maintenance HD patients had radius, hip, and lumbar spine bone mineral density (BMD) assessed by dual‐energy X‐ray absorptiometry and coronary artery calcification score (CACS) measured by electron‐beam computed tomography. The associations between site‐specific BMD parameters, CACS, and serum fetuin‐A levels were studied in maintenance HD patients. CACS, mass, and volume of plaques in coronary arteries were significantly higher in patients with a T‐score below ?2.5 than above in the proximal region of the radius, neck and trochanter of the femur, and the lumbar spine. Mean serum fetuin‐A concentration was 0.636 ± 0.118 g/L in maintenance HD patients and it was less than healthy controls (0.829 ± 0.100 g/L, P < 0.0001). CACS, mass, and volume of plaques in coronary arteries correlated significantly with the serum fetuin‐A levels. Moreover, significant positive correlations were shown between the serum fetuin‐A levels, BMD values, and T‐scores of proximal radius, neck, and trochanter of the femur, but not with the lumbar spine. The present study demonstrates an association between serum fetuin‐A levels, coronary artery calcification, and bone mineral densities—except for the lumbar spine, in maintenance HD patients. However, the results should be interpreted with caution because of the cross‐sectional design of the study.