血液透析患者原发病因及高血压和贫血状况的多中心调查

目的调查佛山地区血液透析患者的原发病因及高血压、贫血状况。方法收集2012年佛山市21家医院2610例血液透析患者的基本情况、原发病因、合并高血压、贫血状况、血白蛋白水平等有关临床资料进行分析。结果佛山地区21家医院2610例血液透析患者中，其原发病分别为原发性肾小球肾炎1278例（占48．9％）、糖尿病肾脏疾病505例（占19．3％）和高血压肾损害219例（占8．4％）。梗阻性肾病、痛风性肾病、多囊肾病、狼疮肾炎、小管间质性。肾病、其他原因及原因未明者分别为191例（占7．3％）、65例（占2．5％）、60例（占2．3％）、39例（占1．5%）、26例（占1．0％）、89例（占3．4％）、138例（占5．3％）。血液透析患者高血压患者1804例，其发病率达86．6％，治疗率为83．7％，血压控制低于140／90mm Hg水平者1227例（占47.0%A），血压控制不达标1383例（占53％）。高血压控制常需多种降压药联合应用，仅269例（占14．9％）患者应用1种降压药，应用2、3、4和5种或5种以上者分别为529例（占29．3％）、606例（占33．6％）、312例（占17．3％）和86例（占4．9％）。血红蛋白（hemoglobin，Hb）〈110g／L的患者1832例（占70．2％），Hb≥110g／L者仅778例（占29．8％）。有493例（占18．9％）患者血浆白蛋白水平低于35g／L，有647例（占24．8％）患者血浆白蛋白水平高于40g／L。结论血液透析患者的病因主要是原发性肾小球肾炎、糖尿病肾脏疾病、高血压肾损害、梗阻性肾病，高血压和贫血控制不达标仍较突出。

A multi-center investigation of etiology,hypertension and anemia status in hemodialysis patients

Objective To investigate the primary causes of hemodialysis patients,and hyperten- sion and anemia status in Foshan area. Methods The causes of ESRD, the status of hypertension and anemia,treatment of anti-hypertension, and the level of plasma albumin in 2 610 cases were analyzed from 21 hemodialysis centers in Foshan area. Results Chronic glomerulonephritis accounted for 1 278 cases（48. 9%） as the leading cause of ESRD,followed by diabetic kidney disease 505 cases（19. 3%）, hypertensive nephropathy 219 cases （8. 4% ）, and obstructing nephropathy 191 cases （7. 3% ）. The prevalence of hypertension in the hemodialysis patients was 86. 6%, and the treatment rate in those pa- tients was 83.7%. The patients with blood pressure 〈 140/90 mm Hg accounted for 1 227 cases （47. 0%）. Persistent hypertension occurred in 1 383 cases（53%） of the hemodialysis patients despite the use of antihypertensive drugs. 269 cases（14. 9%） patients were treated with only one kind of anti- hypertensive drug, but 529 cases（29. 3 % ） with 2 kinds, 606 cases （33. 6 %） with 3 kinds, 312 cases （17. 3%） with 4 kinds,and 88 cases（4. 9%） with 5 kinds or more. There were 1 832 cases（70. 2%） patients with Hb less than 110 g/L. There were 493 cases（18.9% ） patients whose plasma albumin concentration was 〈35 g/L. There were 647 cases（24. 8%） patients whose plasma albumin concentra- tion was ≥40 g/L. Conclusions Chronic glomerulonephritis, diabetic kidney disease, hypertensive ne- phropathy and obstructing nephropathy are the main causes of ESRD. The effect of anti-hypertensionand renal anemia treatment is unsatisfactory.