在美国退伍军人中,突然过渡,需要透析的AKI和ESKD的早期死亡率之间的关联
Raymond K Hsu1, Anna D Rubinsky2, Michael G Shlipak3
1Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. raymond.hsu@ucsf.edu.
BMC nephrology
|November 14, 2023
概括
开始透析后的高早期死亡率与功能急剧下降有关. 在末期病 (ESKD) 之前,功能突然下降显著增加了透析患者的早期死亡风险.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 内部医学 内部医学
- 公共卫生 公共卫生
背景情况:
- 在慢性透析的最初几个月观察到高死亡率.
- 前末期病 (ESKD) 功能轨迹预测透析后的早期死亡.
研究的目的:
- 调查透析前功能急剧下降和需要透析的急性损伤 (AKI-D) 与透析开始后的早期死亡率之间的关联.
主要方法:
- 利用美国退伍军人卫生管理局和USRDS (2009-2013) 的国家数据.
- 定义突发过渡为平均门诊EGFR≥30毫升/分钟/1.73m2在ESKD前1年内.
- 在ESKD前30天内通过住院肌和透析计费码识别AKI-D.
- 采用多变量比例危险模型来评估死亡风险.
主要成果:
- 18%的发生血液透析患者表现出功能急剧下降.
- 有或没有AKI-D的突然过渡显示出早期死亡风险最高 (aHR 2.10).
- 没有突然过渡的AKI-D具有适度增加的早期死亡风险 (aHR 1.19).
结论:
- 在ESKD发生之前的一年内,近五分之一的发生血液透析患者经历了脏功能急剧下降.
- 急性功能下降与ESKD发病后的早期死亡率增加密切相关.
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