摘要
目的回顾性分析2020年武汉市第一医院维持性血液透析(maintenance hemodialysis,MHD)死亡患者流行病学情况,为提高血液透析患者生存质量提供参考。方法收集2020年全年武汉市第一医院血液透析中心84例MHD死亡患者临床资料,分析死亡患者一般情况、原发病史、既往史、透析通路、透析频次、透析龄、死亡原因等;以《血液净化标准操作规程sop(2020版)》为参考标准,统计死亡患者末次生化结果达标情况;根据透析通路,透析频次,透析前生化指标进行分组,比较各组间透析生存情况。结果2020年MHD患者病死率为13.3%,死亡患者主要集中在2~4月份,计47例占56.0%。动静脉内瘘(arteriovenous fistula,AVF)组年龄低于非AVF组(中位数61岁比71岁);AVF组透析龄大于非AVF组(中位数54.0个月比30.5个月)。死亡患者原发病首要为慢性肾炎(29.8%),既往史最多的为高血压(83.3%),死亡原因首要为感染(28.6%),透析频次最多为1周3次(60.0%)。末次透析前生化指标血红蛋白(hemoglobin,Hb),血清铁蛋白、血清白蛋白(albumin,Alb)、血钙、血磷、血钾、全段甲状旁腺素(intact parathyroid hormone,iPTH)达标率分别为25%、52.9%、13.4%、55.7%、48.6%、71.4%、16.1%。AVF组透析中位生存时间大于非AVF组(54个月比30.5个月),2周5次透析中位生存时间大于1周3次和1周2次(62.5个月比47个月比23.5个月),血钙<2.1 mmol/L或>2.5 mmol/L的患者透析中位生存时间比2.1~2.5 mmol/L的患者长(62个月比30个月)。结论2020年血液透析死亡患者原发病以慢性肾炎为首,死亡原因以感染为首,以AVF为血管通路的患者和透析频次为2周5次患者透析生存时间更长。
Objective To retrospectively analyze the epidemiology of mortal maintenance hemo⁃dialysis(MHD)patients in 2020 and provide rationales for improving the quality of life of hemodialysis.Methods For84 mortal MHD patients in 2020,the relevant clinical data were collected,including general status,original disease history,previous history,dialysis access,dialysis frequency,duration of dialysis and cause of mortality.Standard Operating Procedures of Blood Purification(2020 Edition)served as a refer⁃ence standard.And the compliance status of the last biochemical results was recorded.The cohort was grouped by dialysis access,frequency of dialysis and pre-dialysis biochemical parameters.And dialysis survival between groups were compared.Results The mortality rate was13.3%.Most cases(n=47,56.0%)occurred during February-April.Arteriovenous fistula(AVF)group was younger than the non-AVF group(median 61 vs 71 years);AVF group had longer dialysis time than non-AVF group(median 54 vs 30.5 months).The primary cause of mortality was chronic nephritis(29.8%),the most frequent previous history hypertension(83.3%),the primary cause of mortality infection(28.6%)and the highest frequency of dialysis thrice a week(60.0%).The compliance rates of the last biochemical parameters of hemoglobin(Hb),ferritin,albumin(Alb),calclum,phosphorus,potassium and iPTHpre-dialysis were 25%,52.9%,13.4%,55.7%,48.6%,71.4%,16.1%.The median survival time on dialysis was lon⁃ger in AVF group than that in non-AVF group(54 vs 30.5 months),the median survival time on dialysis 5 times per 2 weeks longer than 3 times a week and twice a week(62.5 vs 47 vs 23.5 months),Ca<2.1mmol/L or>2.5mmol/L median survival time on dialysis greater than 2.1-2.5 mmol/L group(62 vs 30 months).Conclusion Chronic nephritis was the primary original disease of mortal hemodialysis pa⁃tients in 2020 and infectiona leading cause of mortality.Patients with arteriovenous fistula as vascular ac⁃cessand those with dialysis frequency of 5 times per 2 weeks had a longer survival time
作者
付帅
程力
刘红
闵永龙
李红波
熊飞
Fu Shuai;Cheng Li;Liu Hong;Min Yong-Long;Li Hong-bo;Xiong Fei(Department of Nephrology,First Municipal Hospital,Wuhan 430022,China;Municipal Center for He-modialysis Quality Control,Wuhan 430022,China)
出处
《临床肾脏病杂志》
2022年第1期16-21,共6页
Journal Of Clinical Nephrology
基金
CKD-MBD青年研究基金项目(BCM01010)。
关键词
血液透析
死因构成
流行病学
Hemodialysis
Proportion of specific mortal cause
Epidemiology
