PDF(Pubmed)
Abstract：
UNASSIGNED: The survival benefit of residual kidney function (RKF) in patients on hemodialysis is presumably due to enhanced fluid management and solute clearance. However, data are lacking on the association of renal urea clearance (CLurea) with specific causes of death.
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.
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.
摘要：
■血液透析患者残余肾功能（RKF）的生存益处可能是由于增强的液体管理和溶质清除。然而,有关肾尿素清除率(CLurea)与特定死亡原因的相关性的数据缺乏.
■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。
■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。
