末期腎疾患の患者における手術前の血液透析のタイミングと手術後の死亡率との関連
Vikram Fielding-Singh1, Matthew W Vanneman1, Tristan Grogan2
1Department of Anesthesiology, Perioperative, and Pain Medicine, School of Medicine, Stanford University, Stanford, California.
JAMA
|November 3, 2022
まとめ
手術を受ける患者では,血液透析と手術の間の間隔が長ければ,手術後の死亡リスクが増加します. 手術の同じ日に血液透析を受けることは,より長い透析手順の隙間から生じるリスクを軽減する死亡率と関連しています.
科学分野:
- 腎臓科
- 手術 の 結果
- 公衆衛生
背景:
- 末期性腎臓病 (ESKD) の患者にとって,選択手術前の血液透析の最適なタイミングは不明である.
- このタイミングを理解することは この脆弱な集団における 外科治療の成果を改善するために 極めて重要です
研究 の 目的:
- 血液透析から手術までの間隔と,ESKD患者の90日後の死亡率との関連を調査する.
- 同日の血液透析が関連性に影響するかどうかを判断する.
主な方法:
- ESKDのメディケア受給者における110万件以上の処置に関する遡及コホート研究.
- 血液透析と手術の間の1日,2日,3日間の間隔と,同じ日の血液透析の分析
- 90日後の死亡率を評価するために使用されたコックス比例リスクモデル.
主要な成果:
- 血液透析から手術までの間隔の長さは,投与量に応じて90日間の死亡リスクの増加と関連していました.
- 同日透析は,同日透析なしと比較して,著しく低い死亡率に関連していた.
- 同日の血液透析は,透析手順間隔の長さに伴う死亡リスクの増加を弱めた.
結論:
- 血液透析と手術の間の長い間隔は,ESKD患者の術後の死亡リスクを増加させる,特に同じ日に透析が実施されない場合.
- 死亡リスクの絶対的な差は小さい.
- 発見は,手術を受けるESKD患者のために,潜在的残留混同を認識しながら,同じ日の血液透析を検討することを示唆しています.
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