Impact of blood flow rate on mortality in hemodialysis patients
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摘要: 目的 研究透析血流量(blood flow rate,BFR)对维持性血液透析(maintenance hemodialysis,MHD)患者全因死亡率的影响,寻求最佳血流量。方法 从中国国家肾脏数据系统中选择了中国人民解放军陆军特色医学中心肾内科MHD患者进行回顾性研究。根据本研究的BFR中位数,将患者分为BFR≤213.7 mL/min和＞213.7 mL/min两组,主要结局是全因死亡率。结果 共纳入405例MHD患者。BFR在200~250 mL/min之间的患者为341例(84.2%)。BFR≤213.7 mL/min与BFR＞213.7 mL/min全因死亡率之比为49(24.3%)∶26(12.8%)。BFR是MHD患者全因死亡的独立预测因子。BFR在180~250 mL/min范围内,BFR的增加可降低3.6%全因死亡风险(HR=0.974,95%CI:0.957~0.992,P=0.004)。中国人民解放军陆军特色医学中心的最佳血流量cut-off值为211.35 mL/min。在多变量Cox回归分析中,BFR对死亡风险的影响可能在使用高通量透析器、非糖尿病患者和年龄＜60岁的患者中更为显著。结论 BFR＞213.7 mL/min与患者全因死亡率降低独立相关(HR=0.499,95%CI:0.285~0.873,P=0.015)。Abstract: Objective To explore the impact of blood flow rate(BFR) on all-cause mortality in chronic hemodialysis(HD) patients.Methods A total of 405 HD patients were selected from CNRDS(Chinese National Renal Data System).According to the median value of BFR,they were assigned into two groups of BFR≤213.7 mL/min and ＞213.7 mL/min.The primary endpoint was all-cause mortality.Results Among them,341(84.2%) patients had BFR of 200-250 mL/min.The mortality of patients was 49(24.3%) in BFR≤213.7 mL/min and 26(12.8%) in BFR＞213.7 mL/min.BFR was an independent risk factor of mortality.Higher BFR was associated with a decline in all-cause mortality risk(HR:0.974,95%CI:0.957-0.992,P=0.004).Optimal cut-off BFR was 211.35 mL/min.According to multivariate Cox regression analyses,the impact of BFR on mortality was more prominent in patients on a high flux dialyzer,nondiabetic and age＜60 year.Conclusion Within a range of 180-250 mL/min,higher BFR is independently associated with a lower risk of all-cause mortality in chronic HD patients.
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Keywords:
- Mortality /
- Hemodialysis /
- Blood flow rate
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[1] Liyanage T,Ninomiya T,Jha V,et al.Worldwide access to treatment for end-stage kidney disease:a systematic review[J].Lancet,2015,385(9981):1975-1982.DOI: 10.1016/S0140-6736(14)61601-9.
[2] Held PJ,Port FK,Wolfe RA,et al.The dose of hemodialysis and patient mortality[J].Kidney Int,1996,50(2):550-556.DOI: 10.1038/ki.1996.348.
[3] Mandolfo S,Borlandelli S,Ravani P,et al.How to improve dialysis adequacy in patients with vascular access problems[J].J Vasc Access,2006,7(2):53-59.DOI: 10.1177/112972980600700203.
[4] Rafik H,Aatif T,El Kabbaj D.The impact of blood flow rate on dialysis dose and phosphate removal in hemodialysis patients[J].Saudi J Kidney Dis Transpl,2018,29(4):872-878.DOI: 10.4103/1319-2442.239654.
[5] Maheshwari V,Thijssen S,Tao X,et al.A novel mathematical model of protein-bound uremic toxin kinetics during hemodialysis[J].Sci Rep,2017,7(1):10371.DOI: 10.1038/s41598-017-10981-z.
[6] Hassell DR,van der Sande FM,Kooman JP,et al.Optimizing dialysis dose by increasing blood flow rate in patients with reduced vascular-access flow rate[J].Am J Kidney Dis,2001,38(5):948-955.DOI: 10.1053/ajkd.2001.28580.
[7] Kimata N,Karaboyas A,Bieber BA,et al.Gender,low Kt/V,and mortality in Japanese hemodialysis patients:opportunities for improvement through modifiable practices[J].Hemodial Int,2014,18(3):596-606.DOI: 10.1111/hdi.12142.
[8] Chang KY,Kim SH,Kim YO,et al.The impact of blood flow rate during hemodialysis on all-cause mortality[J].Korean J Intern Med,2016,31(6):1131-1139.DOI: 10.3904/kjim.2015.111.
[9] Zhao XJ,Niu QY,Gan LY,et al.Blood flow rate:an independent risk factor of mortality in Chinese hemodialysis patients[J].Semin Dial,2022,35(3):251-257.DOI: 10.1111/sdi.13023.
[10] Arbor Research Collaborative For Health US-DOPPS Practice Monitor.2021.https://www.dopps.org/DPM-HD/DPMSlideBrowser.aspx
[11] Arbor Research Collaborative For Health Canada-DOPPS Practice Monitor.2018.https://www.dopps.org/DPM-HD/Canada/
[12] Arbor Research Collaborative For Health,Germany-DOPPS Practice Monitor.2016.https://www.dopps.org/DPM-HD/Germany/
[13] Amini M,Aghighi M,Masoudkabir F,et al.Hemodialysis adequacy and treatment in Iranian patients:a national multicenter study[J].Iran J Kidney Dis,2011,5(2):103-109.DOI: 10.5254/ijkd.330.
[14] Daugirdas JT.Second generation logarithmic estimates of single-pool variable volume Kt/V:an analysis of error[J].J Am Soc Nephrol,1993,4(5):1205-1213.DOI: 10.1681/ASN.V451205.
[15] Ronald L,Pisoni,Ph D,et al.Facility hemodialysis vascular access use and mortality in countries participating in DOPPS:an instrumental variable analysis[J].Am J Kidney Dis,2009,53(3):475-491.DOI: 10.1053/j.ajkd.2008.10.043.
[16] Borzou SR,Gholyaf M,Zandiha M,et al.The effect of increasing blood flow rate on dialysis adequacy in hemodialysis patients[J].Saudi J Kidney Dis Transpl,2009,20(4):639-642.DOI: 10.4040/jkan.2016.46.5.642.
[17] Vanholder R,Glorieux G,Eloot S.Once upon a time in dialysis:the last days of Kt/V?[J].Kidney Int,2015,88(3):460-465.DOI: 10.1038/ki.2015.155.
[18] Eknoyan G,Beck GJ,Cheung AK,et al.Effect of dialysis dose and membrane flux in maintenance hemodialysis[J].N Engl J Med,2002,347(25):2010-2019.DOI: 10.1056/NEJMoa021583.
[19] Béguin L,Krummel T,Longlune N,et al.Dialysis dose and mortality in haemodialysis:is higher better?[J].Nephrol Dial Transplant,2021,36(12):2300-2307.DOI: 10.1093/ndt/gfab202.
[20] Port FK,Wolfe RA,Hulbert-Shearon TE,et al.Mortality risk by hemodialyzer reuse practice and dialyzer membrane characteristics:results from the usrds dialysis morbidity and mortality study[J].Am J Kidney Dis,2001,37(2):276-286.DOI: 10.1053/ajkd.2001.21290.
[21] Ma L,Zhao S.Risk factors for mortality in patients undergoing hemodialysis:a systematic review and meta-analysis[J].Int J Cardiol,2017,238:151-158.DOI: 10.1016/j.ijcard.2017.02.095.
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