摘要
目的分析围透析期慢性肾脏病(chronic kidney disease,CKD)患者的生存状态,探讨其影响因素,为提高围透析期CKD患者生存率提供研究思路。方法收集2019年1月1日至2021年12月31日期间国药葛洲坝中心医院肾内科所有围透析期CKD患者临床资料,根据随访期内生存结局分为死亡组和生存组。比较两组患者基本情况、原发病相关信息、合并临床症状、实验室检查等,采用Logistic回归分析死亡危险因素。结果纳入研究的围透析期CKD患者共168例,随访期死亡26例,其中未进入透析期死亡3例。两组间一般资料比较,年龄[(66.4±13.1)岁比(57.2±14.3)岁]、纳入CKD管理(15.4%比36.6%)、日常生活能力评分(65.8±9.1比72.4±10.2);合并心血管疾病(50.0%比24.6%)、症状群个数超过3个占比(61.5%比40.8%),差异有统计学意义(P<0.05);两组间实验室检查比较,24 h尿量[(818.2±155.3)mL比(1206.1±197.8)mL]、血红蛋白[(76.5±16.5)g/L比(84.7±17.2)g/L]、白蛋白[(28.8±4.9)g/L比(34.3±5.6)g/L]、C反应蛋白[29.7(7.8,46.6)mg/L比10.3(1.9,25.8)mg/L],差异有统计学意义(P<0.05)。Logistic回归分析提示年龄大于60岁(OR=1.647,95%CI 1.154~6.925)、合并心血管疾病(OR=2.573,95%CI 1.214~8.352)、症状群个数大于3个(OR=2.715,95%CI 1.396~6.937)是围透析期CKD患者死亡的危险因素,纳入CKD管理(OR=0.894,95%CI 0.412~0.973)、24 h尿量大于800 mL(OR=0.878,95%CI0.358~0.953)和白蛋白大于30 g/L(OR=0.926,95%CI 0.508~0.966)是围透析期CKD患者死亡的保护性因素。结论围透析期CKD患者死亡风险较高,纳入CKD管理、保护残余尿量、改善低蛋白状况可能有助于提高患者围透析期CKD患者生存率。
Objective To explore the survival status of patients with chronic kidney disease(CKD),explore its influencing factors and provide research rationales for improving the survival rate of CKD patients during peri-dialysis period.Methods Clinical data were reviewed for 168 CKD patients during peri-dialysis period from January 1,2019 to December 31,2021.They were assigned into death and survival groups according to the survival outcome during follow-ups.Basic profiles,information related to primary disease,concurrent clinical symptoms and laboratory tests were compared between two groups and the risk factors for death analyzed by Logistic regression.Results Twenty-six deaths occurred during follow-ups,including 3 deaths not entering dialysis.When comparing general profiles between two groups,the differences were statistically significant(P<0.05)for age(66.4±13.1 vs 57.2±14.3),inclusion in CKD management(15.4%vs 36.6%),self-care capability of daily life score(65.8±9.1 vs 72.4±10.2)and comorbid cardiovascular disease(50.0%vs 40.8%);comparison of laboratory tests between two groups:24-hour urine volume(818.2±155.3 vs 1206.1±197.8),hemoglobin(76.5±16.5 vs 84.7±17.2),albumin(28.8±4.9 vs 34.3±5.6)and C-reactive protein[29.7(7.8,46.6)vs 10.3(1.9,25.8)]with statistically significant differences(P<0.05).Logistic regression analysis indicated that age>60 years(OR=1.647,95%CI 1.154-6.925),comorbid cardiovascular disease(OR=2.573,95%CI 1.214-8.352)and number of symptom clusters>3(OR=2.715,95%CI 1.396-6.937)were risk factors for death.Inclusion in CKD management(OR=0.894,95%CI 0.412-0.973),24-hour urine output>800 mL(OR=0.878,95%CI 0.358-0.953)and albumin>30 g/L(OR=0.926,95%CI 0.508-0.966)were protective factors for death in CKD patients during peri-dialysis period.Conclusions CKD patients with during peri-dialysis period are at a higher risk of death.Incorporating CKD management,protecting residual urine volume and improving low protein status may help to improve patient survival.
作者
钱森林
李明
敖华
窦军
张秋玲
程蓉
Qian Sen-lin;Li Ming;Ao Hua;Dou Jun;Zhang Qiu-ling;Cheng Rong(Department of Nephrology,Gezhouba Central Hospital of Sinopharm/Third Clinical Medical College of Three Gorges University,Yichang 443000,China)
出处
《临床肾脏病杂志》
2023年第8期635-640,共6页
Journal Of Clinical Nephrology
基金
宜昌市医疗卫生科研指导性项目(K17-08)。
关键词
围透析期
慢性肾脏病
生存状况
影响因素
Peri-dialysis
Chronic kidney disease
Survival status
Influencing factors
