背景:中国是世界上维持性血液透析(MHD)患者最多的国家。尽管血液透析技术不断改进,MHD患者的死亡率高于普通人群。了解该人群的死亡特征可以更好地促进临床实践,从而提高患者的生存率。
方法:我们收集了2014-2020年北京血液净化质量控制与改进中心数据库中登记的MHD患者的人口统计学和临床数据。计算了年死亡率和终末期肾病(ESRD)的主要原因,透析年份,并对死亡患者的死亡原因进行了分析。
结果:(1)纳入24,363例MHD患者,2014年至2020年,其中6065名患者死亡。年死亡率在7.4%和8.0%之间波动。中位死亡年龄为70.0(60.8-79.0)岁,男女比例为1.27:1(2)。死亡患者ESRD的前三位主要原因是慢性肾小球肾炎(CGN),糖尿病肾病(DN),高血压肾病(HN)。年死亡率比较显示DN>HN>CGN(3)。死亡患者的透析年份中位数为3.7(1.8-6.9)年,每年缓慢增加。糖尿病患者的透析年限比非糖尿病患者短(3.4vs.4.1年,Z=8.3,P<0.001)(4)。死亡的主要原因是心血管疾病(20.2%),猝死(18.1%),感染(17.9%),和脑血管疾病(12.6%)。心血管疾病死亡的比例,感染,糖尿病患者的猝死率较高(22.2%,20.2%,和20.0%)比没有糖尿病的患者(18.4%,15.8%,和16.3%)。猝死是青年(18-44岁;27.0%)和中年(45-64岁;20.8%)患者的主要死亡原因,而感染是≥75岁患者的主要死亡原因(24.5%).
结论:2014-2020年北京MHD患者年死亡率相对稳定。猝死更容易发生在中青年患者中,更多年龄≥75岁的患者死于感染。
China has the largest number of patients on maintenance hemodialysis (MHD) worldwide. Despite continuous improvements in hemodialysis techniques, patients on MHD have a higher mortality rate than the general population. Understanding the characteristics of death in this population can better promote clinical practice, thereby improving patients\' survival.
We collected demographic and clinical data for patients on MHD registered in the Beijing Blood Purification Quality Control and Improvement Center database from 2014 to 2020. The annual mortality rate was calculatedand the primary cause of end-stage renal disease (ESRD), dialysis vintage, and cause of death among deceased patients were analyzed.
(1) 24,363 patients on MHD were included, of which 6,065 patients died from 2014 to 2020. The annual mortality rate fluctuated between 7.4% and 8.0%. The median age of death was 70.0 (60.8-79.0) years and the male to female ratio was 1.27:1 (2). The top three primary causes of ESRD in deceased patients were chronic glomerulonephritis (CGN), diabetic nephropathy (DN), and hypertensive nephropathy (HN). Comparison of the annual mortality rate showed DN > HN > CGN (3). The median dialysis vintage of deceased patients was 3.7 (1.8-6.9) years, which slowly increased annually. Patients with diabetes had a shorter dialysis vintage than patients without diabetes (3.4 vs. 4.1 years, Z = 8.3, P < 0.001) (4). The major causes of death were cardiovascular disease (20.2%), sudden death (18.1%), infection (17.9%), and cerebrovascular disease (12.6%). Proportions of death from cardiovascular disease, infection, and sudden death were higher in patients with diabetes (22.2%, 20.2%, and 20.0%) than patients without diabetes (18.4%, 15.8%, and 16.3%). Sudden death was the leading cause of death in young (18-44 years; 27.0%) and middle aged (45-64 years; 20.8%) patients, whereas infection was the leading cause of death in patients aged ≥ 75 years (24.5%).
The annual mortality rate of patients on MHD in Beijing was relatively stable from 2014 to 2020. Sudden death was more likely to occur in young and middle-aged patients, and more patients aged ≥ 75 years died from infections.