事故性透析患者の高度と全因死亡率
Wolfgang C Winkelmayer1, Jun Liu, M Alan Brookhart
1Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont St, Ste 3-030, Boston, MA 02120, USA. wwinkelmayer@partners.org
JAMA
|February 5, 2009
まとめ
より高い標高は,透析患者の死亡率の低下と関連しています. この研究は,より高い標高で生活することが,透析を受けている人々の生存率を改善することを示唆しています.
科学分野:
- ネフロロジーはネフロロジーを用います.
- 環境衛生 環境衛生 環境衛生
- エピデミオロジー エピデミオロジー
背景:
- 高地での透析を受けている患者は,低量のエリトロポエチンが必要ですが,ヘモグロビン濃度は高くなります.
- 高地での低酸素誘発因子による鉄の供給量の増加は,これらの観測を説明する可能性がある.
- 低酸素誘発の要因は,患者の罹病率と死亡率に影響を与える経路に影響を与えます.
研究 の 目的:
- 透析を開始する患者の死亡率に高度が影響するかどうかを調査する.
- 住居の高さと透析患者の全因死亡率との関連を分析する.
主な方法:
- リトロスペクティブコホート研究では,1995年から2004年の間に透析を開始した米国患者804,812人が参加しました.
- 患者は住居郵便番号の高さによって層分化され,生存率は比例リスクモデルを使用して分析されました.
- 共同変数は,人口統計,透析方式,併発症,検査値を含み,死亡率は5年後に検閲された.
主要な成果:
- 1000人年あたりの粗末死亡率は,標高の上昇に伴い,220.1 (<76 m) から177.2 (>1828 m) に減少した.
- 多変量分析は,標高と死亡率の間の有意な逆相関を示した;相対的な死亡率は,標高のカテゴリーの増加とともに0.97から0.85に減少した.
- 年齢と性別で標準化された死亡率は,全人口と比較して,透析患者の高度により著しく減少した.
結論:
- 高度が高いことは,透析を受けている米国の患者の全因死亡率と逆に関連しています.
- 高地での生活は,透析中の患者にとって生存上の利点をもたらす可能性があります.
- 鉄の利用可能性や低酸素症に起因する要因などのメカニズムに関するさらなる研究が必要である.
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