PDF(Pubmed)
Abstract：
BACKGROUND: Pre-haemodialysis (HD) serum creatinine levels are reliable and inexpensive markers of muscle mass and important predictors of survival in patients with stable chronic HD. We aimed to assess whether changes in pre-HD serum creatinine levels during a 2-year period are linked to long-term patient survival.
METHODS: We retrospectively analysed patients enrolled in a periodic HD quality assessment program. Of the 21 846 participants in the fourth HD quality assessment program, 13 765 were presented in the fifth, of which 10 299 eligible patients were included in this study. We assessed the change in serum creatinine levels over 2 years. The patients were categorized into the following three groups: stable group (patients with change in serum creatinine < 1 mg/dL during 2 years of HD, n = 5664), increasing group (patients with increase in serum creatinine ≥ 1 mg/dL, n = 2419) and decreasing group (patients with decrease in serum creatinine ≥ 1 mg/dL, n = 2216).
RESULTS: The duration of HD at baseline was 62-83 months, with diabetic kidney disease being the most common cause of kidney failure in 36.4% of patients. The 5-year patient survival rates in the stable, increasing and decreasing groups were 69.1%, 71.3% and 66.8%, respectively. The decreasing group had poorer patient survival than the other two groups (P = 0.083 for stable vs. increasing group; P = 0.011 for stable vs. decreasing group; P < 0.001 for increasing vs. decreasing group). There was no significant difference in the cardiovascular event-free survival rate among the three groups. Multivariable Cox regression analyses revealed the highest hazard ratio (HR) for mortality in the decreasing group (HR 1.33, 95% confidence interval [CI] 1.21-1.45, P < 0.001 vs. stable group; HR 1.50, 95% CI 1.34-1.69, P < 0.001 vs. increasing group). The increasing group exhibited a lower risk of mortality than the stable group (HR 0.88, 95% CI 0.81-0.97, P = 0.008). Subgroup analyses based on age, HD vintage, sex, Charlson comorbidity index score, presence of diabetes and baseline serum creatinine level tertiles revealed that the decreasing group exhibited the highest mortality among all subgroups.
CONCLUSIONS: Our results demonstrate that changes in pre-HD serum creatinine levels over 2 years of HD were associated with all-cause mortality in patients undergoing HD. This finding suggests a simple and promising approach for clinicians in the prognosis and management of patients undergoing HD.
METHODS: We retrospectively analysed patients enrolled in a periodic HD quality assessment program. Of the 21 846 participants in the fourth HD quality assessment program, 13 765 were presented in the fifth, of which 10 299 eligible patients were included in this study. We assessed the change in serum creatinine levels over 2 years. The patients were categorized into the following three groups: stable group (patients with change in serum creatinine < 1 mg/dL during 2 years of HD, n = 5664), increasing group (patients with increase in serum creatinine ≥ 1 mg/dL, n = 2419) and decreasing group (patients with decrease in serum creatinine ≥ 1 mg/dL, n = 2216).
RESULTS: The duration of HD at baseline was 62-83 months, with diabetic kidney disease being the most common cause of kidney failure in 36.4% of patients. The 5-year patient survival rates in the stable, increasing and decreasing groups were 69.1%, 71.3% and 66.8%, respectively. The decreasing group had poorer patient survival than the other two groups (P = 0.083 for stable vs. increasing group; P = 0.011 for stable vs. decreasing group; P < 0.001 for increasing vs. decreasing group). There was no significant difference in the cardiovascular event-free survival rate among the three groups. Multivariable Cox regression analyses revealed the highest hazard ratio (HR) for mortality in the decreasing group (HR 1.33, 95% confidence interval [CI] 1.21-1.45, P < 0.001 vs. stable group; HR 1.50, 95% CI 1.34-1.69, P < 0.001 vs. increasing group). The increasing group exhibited a lower risk of mortality than the stable group (HR 0.88, 95% CI 0.81-0.97, P = 0.008). Subgroup analyses based on age, HD vintage, sex, Charlson comorbidity index score, presence of diabetes and baseline serum creatinine level tertiles revealed that the decreasing group exhibited the highest mortality among all subgroups.
CONCLUSIONS: Our results demonstrate that changes in pre-HD serum creatinine levels over 2 years of HD were associated with all-cause mortality in patients undergoing HD. This finding suggests a simple and promising approach for clinicians in the prognosis and management of patients undergoing HD.
摘要：
背景：血液透析（HD）前血清肌酐水平是稳定的慢性HD患者肌肉质量的可靠且廉价的标志物，也是生存的重要预测因子。我们旨在评估2年期间HD前血清肌酐水平的变化是否与患者的长期生存有关。
方法：我们回顾性分析了参加定期HD质量评估计划的患者。第四届HD质量评估计划的21.846名参与者中，13.765在第五，其中10.299例符合条件的患者纳入本研究.我们评估了2年内血清肌酐水平的变化。将患者分为以下三组：稳定组（HD2年期间血清肌酐变化<1mg/dL的患者，n=5664),增加组(血清肌酐增加≥1mg/dL的患者，n=2419）和下降组（血清肌酐下降≥1mg/dL的患者，n=2216）。
结果：基线时HD的持续时间为62-83个月，糖尿病肾病是36.4%患者肾衰竭的最常见原因。患者5年生存率稳定,增加组和减少组分别为69.1%,71.3%和66.8%，分别。下降组的患者生存率低于其他两组（P=0.083增加组；稳定组与减少组；增加与增加组P<0.001递减组)。三组间无心血管事件生存率差异无统计学意义。多变量Cox回归分析显示，死亡率下降组的风险比（HR1.33，95％置信区间[CI]1.21-1.45，P<0.001vs.稳定组；HR1.50，95%CI1.34-1.69，P<0.001vs.增加组)。增加组的死亡风险低于稳定组（HR0.88，95％CI0.81-0.97，P=0.008）。基于年龄的亚组分析，高清复古，性别,Charlson合并症指数评分,糖尿病和基线血清肌酐水平的三位数显示,在所有亚组中,降低组的死亡率最高.
结论：我们的结果表明，HD患者2年中HD前血清肌酐水平的变化与HD患者的全因死亡率相关。这一发现为临床医生在HD患者的预后和管理中提供了一种简单而有希望的方法。
方法：我们回顾性分析了参加定期HD质量评估计划的患者。第四届HD质量评估计划的21.846名参与者中，13.765在第五，其中10.299例符合条件的患者纳入本研究.我们评估了2年内血清肌酐水平的变化。将患者分为以下三组：稳定组（HD2年期间血清肌酐变化<1mg/dL的患者，n=5664),增加组(血清肌酐增加≥1mg/dL的患者，n=2419）和下降组（血清肌酐下降≥1mg/dL的患者，n=2216）。
结果：基线时HD的持续时间为62-83个月，糖尿病肾病是36.4%患者肾衰竭的最常见原因。患者5年生存率稳定,增加组和减少组分别为69.1%,71.3%和66.8%，分别。下降组的患者生存率低于其他两组（P=0.083增加组；稳定组与减少组；增加与增加组P<0.001递减组)。三组间无心血管事件生存率差异无统计学意义。多变量Cox回归分析显示，死亡率下降组的风险比（HR1.33，95％置信区间[CI]1.21-1.45，P<0.001vs.稳定组；HR1.50，95%CI1.34-1.69，P<0.001vs.增加组)。增加组的死亡风险低于稳定组（HR0.88，95％CI0.81-0.97，P=0.008）。基于年龄的亚组分析，高清复古，性别,Charlson合并症指数评分,糖尿病和基线血清肌酐水平的三位数显示,在所有亚组中,降低组的死亡率最高.
结论：我们的结果表明，HD患者2年中HD前血清肌酐水平的变化与HD患者的全因死亡率相关。这一发现为临床医生在HD患者的预后和管理中提供了一种简单而有希望的方法。
