长期血液透析患者生存预后的前瞻性队列研究

A prospective cohort study on survival outcomes in long-term hemodialysis patients

摘要:

目的 探讨长期血液透析（HD）患者的1年和3年生存率，并分析其生存预后的影响因素。方法 选取2021年12月1日起在皖西卫生职业学院附属医院（六安市第二人民医院）行规律HD的患者，随访截至2024年11月30日。以死亡作为终点事件，将患者分为死亡组与存活组。比较两组患者的临床资料、实验室检查数据、随访期间出现的并发症等；采用单因素或多因素Cox比例风险回归模型分析影响患者生存预后的危险因素；采用Kaplan-Meier生存分析比较不同肾病原发病患者的生存率。结果 共纳入206例长期HD患者，其1年生存率为95.7%，3年生存率为85.0%；其中，原发病为糖尿病肾病患者生存率最低，分别为84.2%和73.2%。Cox比例风险回归模型分析显示，白蛋白水平［H^R =0.911（95% CI：0.856，0.970）］、原发病为糖尿病肾病［H^R =2.470（95% CI：1.092，5.588）］、随访期间并发心血管疾病［H^R =3.589（95% CI：1.561，8.249）］、并发脑卒中［H^R =3.045（95% CI：1.305，7.102）］均为长期HD患者死亡的危险因素（P <0.05）。白蛋白水平［H^R =0.747（95% CI：0.638，0.873）］、年龄增高［H^R =1.087（95% CI：1.019，1.160）］及随访期间并发心血管疾病［H^R =9.248（95% CI：2.422，35.315）］均为原发病为糖尿病肾病患者死亡的危险因素（P <0.05）；年龄增高［H^R =1.064（95% CI：1.011，1.120）］和总胆固醇水平高［H^R =1.760（95% CI：1.150，2.693）］均为原发病为慢性肾小球肾炎及其他肾病患者死亡的危险因素（P <0.05）。结论 白蛋白水平、原发病为糖尿病肾病、并发心血管疾病和脑卒中是长期HD患者生存预后的独立危险因素。

Abstract:

Objective To investigate the 1-year and 3-year survival rates and identify independent prognostic factors in patients undergoing long-term hemodialysis (HD).Methods A cohort study included patients receiving regular HD at the Affiliated Hospital of West Anhui Health Vocational College from December 1, 2021, with follow-up until November 30, 2024. General data, clinical data, complications, and laboratory data were recorded. Patients were divided into death and survival groups. Cox proportional hazards regression was used to identify factors affecting survival. Kaplan-Meier analysis compared survival among patients with different primary renal diseases.Results Among 206 long-term HD patients, the 1-year and 3-year survival rates were 95.7% and 85.0%, respectively. Patients with diabetic nephropathy (DN) as the primary disease had the lowest survival rates (84.2% and 73.2%, respectively). Multivariate Cox analysis identified low serum albumin [H^R = 0.911 (95% CI: 0.856, 0.970) ], DN as the primary disease [H^R = 2.470 (95% CI: 1.092, 5.588) ], and concurrent cardiovascular disease [H^R = 3.589 (95% CI: 1.561, 8.249) ] or stroke [H^R = 3.045 (95% CI: 1.305, 7.102) ] during follow-up as independent risk factors for death (P < 0.05). Subgroup analysis for DN patients identified low serum albumin [H^R = 0.747 (95% CI: 0.638, 0.873) ], advanced age [H^R = 1.087 (95% CI: 1.019, 1.160) ], and concurrent cardiovascular disease [H^R = 9.248 (95% CI: 2.422, 35.315) ] as risk factors. For non-DN patients (chronic glomerulonephritis/others), advanced age [H^R = 1.064 (95% CI: 1.011, 1.120) ] and high total cholesterol [H^R = 1.760 (95% CI: 1.150, 2.693) ] were risk factors.Conclusions The 1-year and 3-year survival rates for long-term HD patients were 95.7% and 85.0%. Serum albumin level, DN, cardiovascular disease, and stroke are significant independent prognostic factors.