维持性血液透析患者早期死亡率及相关危险因素分析

目的分析浙江省新增终末期肾病血液透析患者早期死亡率及其相关危险因素,为降低透析患者早期死亡风险提供依据。方法应用浙江省血液透析登记数据库,回顾性分析2010年1月1日至2018年6月30日期间浙江省新增血液透析患者的早期死亡率及其相关因素,早期死亡的定义为患者透析后90 d内死亡。应用Cox回归模型分析血液透析患者早期死亡的相关危险因素。结果开始透析后第1个月死亡率最高(46.40/100人年),3个月后死亡率逐渐稳定,早期死亡率为25.33/100人年,120 d内、360 d内总体死亡率分别为21.40/100人年、11.37/100人年。年龄≥65岁患者早期高死亡现象尤为明显。老龄(≥65岁,HR=1.981,95%CI 1.319~2.977,P<0.001)、原发病为肿瘤(HR=3.308,95%CI 1.137~5.624,P=0.028)、合并肿瘤(不含原发病为肿瘤,HR=2.327,95%CI 1.200~4.513,P=0.012)、首次透析通路为临时导管(HR=3.632,95%CI 1.806~7.307,P<0.001)、低血白蛋白(<30 g/L,HR=2.181,95%CI 1.459~3.260,P<0.001)、低血红蛋白(每增加0.01 g/L,HR=0.861,95%CI 0.793~0.935,P=0.001)、高密度脂蛋白偏低(<0.7 mmol/L,HR=1.796,95%CI 1.068~3.019,P=0.027)和C反应蛋白偏高(≥40 mg/L,HR=1.889,95%CI 1.185~3.012,P=0.008)是血液透析患者早期死亡的独立危险因素。结论血液透析患者开始透析后早期死亡率较高,3个月后死亡率逐渐趋于稳定。老龄、低血白蛋白、低血红蛋白、高密度脂蛋白偏低、C反应蛋白偏高、原发病为肿瘤、合并肿瘤以及首次血管通路为临时导管是维持性血液透析患者早期死亡的重要危险因素。

Analysis of early mortality and related risk factors in maintenance hemodialysis patients

Objective To analyze the early mortality and related risk factors of new hemodialysis patients in Zhejiang province, and provide basis for reducing the death risk of hemodialysis patients. Methods The early mortality and related factors of new hemodialysis patients from January 1, 2010 to June 30, 2018 were retrospectively analyzed using the database of Zhejiang province hemodialysis registration. The early mortality was defined as death within 90 days of dialysis. Cox regression model was used to analyze the related risk factors of the early mortality in hemodialysis patients. Results The mortality was the highest in the first month after dialysis (46.40/100 person year), and gradually stabilized after three months. The early mortality was 25.33/100 person year. The mortality within 120 days and 360 days were 21.40/100 person year and 11.37/100 person year, respectively. The elderly (≥65 years old, HR=1.981, 95%CI 1.319-2.977, P＜0.001), primary tumor (HR=3.308, 95%CI 1.137-5.624, P=0.028), combined with tumors (not including the primary tumor, HR=2.327, 95%CI 1.200-4.513, P=0.012), temporary catheter (the initial dialysis pathway, HR=3.632, 95%CI 1.806-7.307, P＜0.001), lower albumin (＜30 g/L, HR=2.181, 95%CI 1.459-3.260, P＜0.001), lower hemoglobin (every 0.01 g/L increase, HR=0.861, 95%CI 0.793-0.935, P=0.001), lower high density lipoprotein (＜0.7 mmol/L, HR=1.796, 95%CI 1.068-3.019, P=0.027) and higher C reactive protein (≥40 mg/L, HR=1.889, 95%CI 1.185-3.012, P=0.008) were the risk factors of early death for hemodialysis patients. Conclusions The early mortality of hemodialysis patients is high after dialysis, and gradually stable after 3 months. The elderly, primary tumor, combined with tumors, the initial dialysis pathway, lower albumin, lower hemoglobin, lower high density lipoprotein and higher C reactive protein are the risk factors of early death for hemodialysis patients.