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| 夜间血液透析患者退出原因及危险因素分析 |
| 薛贤△,陈冬平△,汤晓静,孙丽君,马熠熠,庹素馨,刘玲玲,郁胜强,梅长林* |
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(第二军医大学长征医院肾内科, 解放军肾脏病研究所, 上海 200003
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 分析夜间血液透析（nocturnal hemodialysis，NHD）患者退出的原因并探讨其危险因素。方法 收集第二军医大学长征医院2009年2月至2016年11月行NHD满3个月后退出NHD的47例患者和维持NHD的64例患者的临床资料，收集患者一般资料，比较两组患者首次行NHD及末次行NHD时的血红蛋白、血小板、白蛋白、铁蛋白、血钙、血磷、甲状旁腺激素等指标的差异，采用Cox回归模型分析患者退出NHD和死亡的危险因素。结果 47例患者退出NHD，行NHD的平均时间为（31.55±20.30）个月，退出原因分别是死亡、转院、转传统血液透析（CHD）、肾移植及其他。单因素Cox回归分析显示，在原发疾病中，高血压肾病（P=0.007，HR=2.913，95%CI：1.348~6.293）和糖尿病肾病（P=0.047，HR=2.401，95%CI：1.014~5.685）是NHD患者退出的危险因素，慢性肾炎综合征（P<0.001，HR=0.095，95%CI：0.046~0.195）则是保护因素；在血液检测指标中，低白蛋白水平（P=0.007，HR=0.904，95%CI：0.840~0.973）是NHD患者退出的危险因素；高龄（P=0.027，HR=1.052，95%CI：1.006~1.101）是NHD患者退出的危险因素。多因素Cox回归分析显示，低白蛋白水平（P=0.007，HR=0.911，95%CI：0.848~0.991）是NHD患者死亡的独立危险因素。结论 高血压肾病和糖尿病肾病是NHD患者退出的危险因素，慢性肾炎综合征是其保护因素。低白蛋白是NHD患者死亡的独立危险因素。 |
| 关键词: 肾透析 夜间血液透析 传统血液透析 终止治疗的患者 睡眠障碍 |
| DOI：10.16781/j.0258-879x.2017.08.0961 |
| 投稿时间：2017-05-23修订日期：2017-07-03 |
| 基金项目:国家自然科学基金（81400687）. |
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| Causes and risk factors for dropout of nocturnal hemodialysis patients |
| XUE Xian△,CHEN Dong-ping△,TANG Xiao-jing,SUN Li-jun,MA Yi-yi,TUO Su-xin,LIU Ling-ling,YU Sheng-qiang,MEI Chang-lin* |
(Department of Nephrology, Kidney Institute of PLA, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
△Co-first authors
*Corresponding author) |
| Abstract: |
| Objective To explore the causes of nocturnal hemodialysis (NHD) patient dropout and the risk factors for dropout. Methods We collected the clinical data of patients receiving NHD for more than 3 months, of whom 47 patients dropped out and 64 kept receiving NHD from Feb. 2009 to Nov. 2016 in Changzheng Hospital of Second Military Medical University. We investigated the general conditions; and we compared the differences of the blood parameters between the two groups when the patients received NHD for the first time and for the last time, including hemoglobin, platelet, albumin, ferritin, serum calcium, serum phosphorus and parathyroid hormone. We also analyzed the risk factors for NHD dropout or for death using Cox regression analysis model. Results Among 111 patients, 47 patients had withdrawn from NHD, with their average time for NHD being (31.55±20.30) months, and the causes for dropout included death, transferring to other hospitals, turning to conventional hemodialysis (CHD), renal transplantation and others. Univariate Cox regression analysis showed that hypertensive nephropathy (P=0.007, HR=2.913, 95%CI: 1.348-6.293) and diabetic nephropathy (P=0.047, HR=2.401, 95%CI: 1.014-5.685) were risk factors for NHD patient dropout, while chronic nephritis syndrome (P<0.001, HR=0.095, 95%CI 0.046-0.195) was a protective factor; blood albumin (P=0.007, HR=0.904, 95%CI:0.840-0.973) and age (P=0.027, HR=1.052, 95%CI:1.006-1.101) were risk factors for NHD patient dropout. Multivariate Cox regression analysis showed that albumin level (P=0.007, HR=0.911, 95%CI: 0.848-0.991) was an independent risk factor for death in NHD patients. Conclusion Hypertensive nephropathy and diabetic nephropathy are the risk factors for NHD patients dropout, while chronic nephritis syndrome was a protective factor. Low serum albumin level is an independent risk factor for death in NHD patients. |
| Key words: renal dialysis nocturnal hemodialysis conventional hemodialysis patient dropouts sleep disorders |
