早期开始使用导管进行血液透析可能与更高的死亡率相关:倾向评分分析。

IF 1.4 4区 医学 Q3 UROLOGY & NEPHROLOGY
Seminars in Dialysis Pub Date : 2023-07-01 Epub Date: 2023-04-23 DOI:10.1111/sdi.13157
Gustavo Laham, Gervasio Soler Pujol, Jenny Guzman, Natalia Boccia, Anabel Abib, Carlos H Diaz
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引用次数: 0

摘要

引言:决定何时以及如何开始血液透析(HD)仍然存在争议。早期启动(ES)似乎显示出缺乏益处。ES组的“提前期偏倚”和合并症与不同的结果相关。另一方面,血管通路(VA)的类型对患者生存的影响是公认的。我们的目的是评估HD早期启动(ES)与晚期启动(LS)的生存率,同时考虑所使用的血管通路(VA)。方法:1995年1月至2018年6月,503名偶发患者在我们的透析室开始HD。eGFR通过CKD-EPI方程估计。糖尿病(DM)、冠状动脉疾病(CD)和外周血管疾病(PVD)被认为是合并症。根据eGFR和VA,患者被分为四组:G1:ES(eGFR>7mL/min)和导管(ES + C) ,G2:ES伴瘘或移植物(F/G)(ES+ F/G),G3:LS(eGFR<7 mL/min),带导管(LS + C) ,和G4:带F/G的LS(LS + F/G)。定义ES或LS的临界值是基于这503名患者的eGFR中位数。我们通过Kaplan-Meier和log-rank检验比较了患者的生存率。四组在匹配倾向评分(PS)前后进行比较。Cox分析用于确定死亡率预测因素的影响。结果:中位eGFR为7(5.3-9.5)mL/min/1.73 m2,中位随访时间为30.9(13-50)个月,52.1%的患者进入F/G通道,46.9%的患者在观察期内死亡。在四组中,ES + C年龄明显较大,糖尿病患者和共病患者较多,而LS组的磷酸盐血症、iPTH、白蛋白和血红蛋白明显较高。在倾向得分(PS)匹配之前,ES + C组生存率低(p 结论:在这项回顾性研究中,ES+ HD上的C与LS相比死亡率更高。这种相关性在PS匹配后持续存在。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Early start hemodialysis with a catheter may be associated with greater mortality: A propensity score analysis.

Introduction: Deciding when and how to initiate hemodialysis (HD) is still controversial. An early start (ES) seems to show a lack of benefit. "Lead time bias" and comorbidities have been associated with different outcomes in ES groups. On the other hand, it is well accepted that the impact the type of vascular access (VA) has on patient survival. Our aim was to evaluate survival with early start (ES) versus late start (LS) on HD, taking into account the vascular access (VA) used.

Methods: Between 01/1995 and 06/2018, 503 incidental patients initiated HD at our Dialysis Unit. eGFR was estimated by the CKD-EPI equation. Diabetes mellitus (DM), coronary disease (CD), and peripheral vascular disease (PVD) were considered comorbid conditions. According to eGFR and VA, patients were divided into four groups: G1: ES (eGFR > 7 mL/min) with catheter (ES + C), G2: ES with fistula or graft (F/G) (ES + F/G), G3: LS (eGFR< 7 mL/min) with catheter (LS + C), and G4: LS with F/G (LS + F/G). The cut-off value to define ES or LS was based on median eGFR for these 503 patients. We compared patient's survival rates by Kaplan-Meier and log-rank test. The four groups were compared before and after matching with propensity scores (PS). Cox analysis was performed to determine the impact of predictors of mortality.

Results: Median eGFR was 7 (5.3-9.5) mL/min/1.73 m2 , median follow-up time was 30.9 (13-50) months, 52.1% had F/G access at entry, and 46.9% died during the observation period. Among the four groups, the ES + C were significantly older, and there were more diabetics and comorbid conditions, while phosphatemia, iPTH, albumin, and hemoglobin were significantly higher in the LS groups. Before propensity score (PS) matching, the ES + C group had a poor survival rate (p < 0.0001), while LS + F/G access had the best survival. After PS, a total of 180 patients were selected in the same four groups and ES + C kept showing a statistically significant poorer survival. Multivariate analysis revealed that ES + C was an independent predictor of mortality.

Conclusion: In this retrospective study, ES + C on HD was associated with a higher mortality rate than LS. This association persisted after PS matching.

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来源期刊
Seminars in Dialysis
Seminars in Dialysis 医学-泌尿学与肾脏学
CiteScore
3.00
自引率
6.20%
发文量
91
审稿时长
4-8 weeks
期刊介绍: Seminars in Dialysis is a bimonthly publication focusing exclusively on cutting-edge clinical aspects of dialysis therapy. Besides publishing papers by the most respected names in the field of dialysis, the Journal has unique useful features, all designed to keep you current: -Fellows Forum -Dialysis rounds -Editorials -Opinions -Briefly noted -Summary and Comment -Guest Edited Issues -Special Articles Virtually everything you read in Seminars in Dialysis is written or solicited by the editors after choosing the most effective of nine different editorial styles and formats. They know that facts, speculations, ''how-to-do-it'' information, opinions, and news reports all play important roles in your education and the patient care you provide. Alternate issues of the journal are guest edited and focus on a single clinical topic in dialysis.
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