事故透析患者的高度和全因死亡率
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
概括
更高的海拔与透析患者的死亡率降低有关. 这项研究表明,生活在更高的海拔上可能会改善透析患者的生存率.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 环境健康 环境健康
- 流行病学 流行病学
背景情况:
- 在高海拔地区进行透析的患者需要更低的红蛋白剂量,但血红蛋白水平较高.
- 由于高海拔地区的缺氧诱导因素增加了铁的可用性,这可能解释了这些观察结果.
- 缺氧诱导的因素影响影响患者发病率和死亡率的途径.
研究的目的:
- 调查高度是否影响开始透析的患者的死亡率.
- 分析透析患者住院升高与全因死亡率之间的关联.
主要方法:
- 一项回顾性队列研究包括804,812名在1995年至2004年期间开始透析的美国患者.
- 患者按住宅邮政编码的高度分层,并使用比例危险模型分析生存率.
- 共变量包括人口统计学,透析方式,并发症和实验室值;死亡率在5年后被审查.
主要成果:
- 随着海拔高度的增加,每1000人/年的原始死亡率下降,从220.1 (<76米) 降至177.2 (>1828米).
- 多变量分析显示,高度和死亡率之间存在显著的反向关联;随着高度类别的增加,相对死亡率从0.97降至0.85.
- 与一般人口相比,透析患者的年龄和性别标准化死亡率与高度相比下降得更为显著.
结论:
- 更高的海拔高度与美国透析患者的全因死亡率相反相关.
- 生活在更高的海拔上可能为透析患者提供生存益处.
- 对机理的进一步研究,如铁的可用性和缺氧诱导的因素是有必要的.
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