UNASSIGNED: We conducted a longitudinal cohort study of 39,623 adults initiating thrice-weekly in-center hemodialysis from 2007 to 2011 and had data on renal CLurea and urine volume. Multivariable cause-specific proportional hazards model was used to examine the associations between baseline RKF and cause-specific mortality, including sudden cardiac death (SCD), non-SCD cardiovascular death (CVD), and non-CVD. Restricted cubic splines were fitted for change in RKF over 6 months after initiating hemodialysis.
UNASSIGNED: Among 39,623 patients with data on baseline renal CLurea and urine volume, there was a significant trend toward a higher mortality risk across lower RKF levels, irrespective of cause of death in a case-mix adjustment model (Ptrend < 0.05). Adjustment for ultrafiltration rate (UFR) slightly attenuated the association between low renal CLurea and high cause-specific mortality, whereas adjustment for highest potassium did not have substantial effect. Among 12,169 patients with data on change in RKF, a 6-month decline in renal CLurea showed graded associations with SCD, non-SCD CVD, and non-CVD risk, whereas the graded associations between faster 6-month decline in urine output and higher death risk were clear only for SCD and non-CVD.
UNASSIGNED: Lower RKF and loss of RKF were associated with higher cause-specific mortality among patients initiating thrice-weekly in-center hemodialysis.
■我们从2007年至2011年对39,623名开始每周三次中心血液透析的成年人进行了一项纵向队列研究,并获得了有关肾脏CL脲和尿量的数据。多变量原因特异性比例风险模型用于检查基线RKF和原因特异性死亡率之间的关联。包括心脏性猝死(SCD),非SCD心血管死亡(CVD),非CVD在开始血液透析后6个月内,对RKF的变化进行了有限的立方样条拟合。
■在39,623例患者中,有基线肾脏CLurea和尿量的数据,在较低的RKF水平下,有较高的死亡风险趋势,在病例组合调整模型中,与死亡原因无关(Ptrend<0.05)。超滤率(UFR)的调整略微减弱了低肾性CL脲和高病因特异性死亡率之间的关联。而对最高钾的调整没有实质性影响。在有RKF变化数据的12169名患者中,6个月的肾脏CLurea下降显示与SCD分级相关,非SCDCVD,和非CVD风险,而6个月尿量下降较快和死亡风险较高之间的分级关联仅在SCD和非CVD中明确.
■在开始每周三次中心血液透析的患者中,较低的RKF和RKF丢失与较高的病因特异性死亡率相关。