上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

血液透析患者透析初始月残肾功能对长期预后的影响

张玉梅，卞志翔，陈佩华，郭丽萍，胡 春，潘 瑜   

  1. 上海交通大学 医学院附属第三人民医院肾脏内科，上海 201900
  • 出版日期:2015-01-28 发布日期:2015-01-29
  • 作者简介:张玉梅（1978—）， 女， 硕士生; 电子信箱: zhang_yumei@126.com。
  • 基金资助:

    国家自然科学基金青年科学基金项目(81300652)；上海市科委项目（ZR1424300）

Effects of residual renal function before hemodialysis on long-term prognosis of patients undergoing hemodialysis

ZHANG Yu-mei, BIAN Zhi-xiang, CHEN Pei-hua, GUO Li-ping, HU Chun, PAN Yu   

  1. Department of Nephrology, Shanghai Third People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201900, China
  • Online:2015-01-28 Published:2015-01-29
  • Supported by:

    Program of Youth Science Foundation of National Natural Science Foundation of China, 81300652; Foundation of Science and Technology Commission of Shanghai Municipality, ZR1424300

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摘要：

目的 评估血液透析患者透析初始月残肾功能与透析长期预后的关系。方法 收集2005年1月—2013年9月新进入维持性血液透析治疗的终末期肾病(ESRD)成年患者资料，随访至2014年3月31日。根据透析初始月估算的肾小球滤过率（eGFR）分为≥10.5、8.1~10.4、6~8和<6 mL·min-1·(1.73 m2)-1 共4组。eGFR评估采用肾脏病膳食改良试验（MDRD）简化公式；终点事件为全因死亡。结果 294例患者透析初始eGFR为5.43（2.27~13.92）mL·min-1·(1.73 m2)-1，随访期间死亡65例（22.1%），前三位死因依次为脑血管意外、感染和心血管疾病。随着透析初始eGFR降低，血尿素氮、肌酐、尿酸、血磷、钙磷乘积、铁蛋白、高尿酸血症比例、Charlson合并症指数（CCI）0~2分比例有逐渐升高的趋势，合并糖尿病比例、红细胞压积、CCI≥5分比例有逐渐下降的趋势。多因素Cox回归分析显示血液透析患者长期预后的保护因素为血肌酐，危险因素为CCI、合并脑血管疾病、合并慢性阻塞性肺病、因其他原因行急诊透析及三酰甘油。对急诊透析组、择期透析组,白蛋白≥35 g/L组、白蛋白<35 g/L组，透析初始年龄≥65岁组、透析初始年龄<65岁组进行分层分析，未发现透析初始eGFR高长期预后好。结论 虽然随着透析初始eGFR降低，贫血更严重，高尿酸血症、钙磷代谢紊乱等并发症明显增多，但未发现透析初始eGFR高的患者长期预后好。透析初始eGFR与血液透析患者长期预后无明显关系。

关键词: 透析初始月残肾功能, 终末期肾病, 血液透析预后

Abstract:

Objective To evaluate the relationship between the residual renal function before hemodialysis and the long-term prognosis of patients who undergo hemodialysis. Methods Data of adult patients with the end-stage renal disease (ESRD) who underwent the maintenance hemodialysis between January, 2005 and September, 2013 was collected. Patients were followed up till March 31, 2014. According to the estimated glomerular filtration rate (eGFR) before hemodialysis, patients were divided into four groups and their eGFRs were ≥10.5, 8.1-10.4, 6-8, and <6 mL·min-1·(1.73 m2)-1, respectively. The simplified equation of modification of diet in renal disease (MDRD) was adopted to evaluate the eGFR. The endpoint event was all-cause mortality. Results The median eGFR of 294 patients before hemodialysis was 5.43 (2.27-13.92) mL·min-1·(1.73 m2)-1. A total of 65 patients died during the period of follow-up and the top three causes of death were cerebrovascular accidents, infections, and cardiovascular diseases. With the decrease of eGFR after hemodialysis, blood urea nitrogen, serum creatinine, serum uric acid, phosphorus, calcium and phosphate product, serum ferritin, proportion of hyperuricacidemia complication, and proportion of Charlson combidity indexes (CCI) between 0-2 gradually increased and proportion of diabetes, hematocrit, and proportion of CCI≥5 gradually decreased. The multivariate Cox regression analysis indicated that the serum creatinine was a protective factor of long term prognosis of patients who underwent the hemodialysis and CCI, combined cerebrovascluar diseases, combined chronic obstructive pulmonary disease, emergent hemodialysis due to other reasons, and triglyceride were risk factors. The stratified analysis was performed for the emergency hemodialysis group, selecting hemodialysis group, albumin <35 g/L group, albumin ≥35 g/L group, age <65 years group, and age ≥65 years group. The results showed that the long-term prognosis of patients with high eGFRs before hemodialysis was not better. Conclusion Although the incidences of anemia, hyperuricacidemia, and calcium and phosphorus metabolism disorder of patients with low eGFRs before hemodialysis are more than those of patients with high eGFRs, the long-term prognosis of patients with high eGFRs before hemodialysis is not better. There is no significant relationship between the eGFR before hemodialysis and the long term prognosis.

Key words: residual renal function at the start of dialysis, end-stage renal disease, hemodialysis prognosis