围透析期慢性肾脏病患者生存状况及影响因素分析

钱森林; 李明; 敖华; 窦军; 张秋玲; 程蓉

doi:10.3969/j.issn.1671-2390.2023.08.004

围透析期慢性肾脏病患者生存状况及影响因素分析

Analysis of survival status and influencing factors of patients with chronic kidney disease during peri-dialysis period

摘要

摘要:
目的分析围透析期慢性肾脏病（chronic kidney disease,CKD）患者的生存状态，探讨其影响因素，为提高围透析期CKD患者生存率提供研究思路。
方法收集2019年1月1日至 2021年12月31日期间国药葛洲坝中心医院肾内科所有围透析期CKD患者临床资料，根据随访期内生存结局分为死亡组和生存组。比较两组患者基本情况、原发病相关信息、合并临床症状、实验室检查等，采用Logistic回归分析死亡危险因素。
结果纳入研究的围透析期 CKD患者共168例，随访期死亡26例，其中未进入透析期死亡3例。两组间一般资料比较，年龄（66.4 ± 13.1）岁比（57.2 ± 14.3）岁、纳入CKD管理（15.4%比36.6%）、日常生活能力评分（65.8 ± 9.1比72.4 ± 10.2 ）；合并心血管疾病（50.0%比24.6%）、症状群个数超过3个占比（61.5%比40.8%），差异有统计学意义（P＜0.05）；两组间实验室检查比较，24 h尿量（818.2 ± 155.3)mL比(1206.1 ± 197.8）mL、血红蛋白（76.5 ± 16.5)g/L比( 84.7 ± 17.2）g/L、白蛋白（28.8 ± 4.9)g/L比(34.3 ± 5.6）g/L、C反应蛋白29.7（7.8，46.6）mg/L比10.3（1.9，25.8）mg/L，差异有统计学意义（P＜0.05）。Logistic回归分析提示年龄大于60岁（OR=1.647, 95%CI 1.154～6.925）、合并心血管疾病（OR=2.573, 95% CI 1.214～8.352）、症状群个数大于3个（OR=2.715, 95%CI 1.396～6.937）是围透析期CKD患者死亡的危险因素，纳入CKD管理（OR=0.894, 95%CI 0.412～0.973）、24 h尿量大于800 mL（OR=0.878, 95%CI 0.358～0.953）和白蛋白大于30 g/L（OR=0.926, 95%CI 0.508～0.966）是围透析期CKD患者死亡的保护性因素。
结论围透析期CKD患者死亡风险较高，纳入CKD管理、保护残余尿量、改善低蛋白状况可能有助于提高患者围透析期CKD患者生存率。

Abstract:
Objective To explore the survival status of patients with chronic kidney disease （CKD）, explore its influencing factors and provide research rationales for improving the survival rate of CKD patients during peri-dialysis period.
Methods Clinical data were reviewed for 168 CKD patients during peri-dialysis period from January 1, 2019 to December 31, 2021. They were assigned into death and survival groups according to the survival outcome during follow-ups. Basic profiles, information related to primary disease, concurrent clinical symptoms and laboratory tests were compared between two groups and the risk factors for death analyzed by Logistic regression.
Results Twenty-six deaths occurred during follow-ups, including 3 deaths not entering dialysis. When comparing general profiles between two groups, the differences were statistically significant （P＜0.05） for age （66.4 ± 13.1 vs 57.2 ± 14.3）, inclusion in CKD management （15.4% vs 36.6%）, self-care capability of daily life score （65.8 ± 9.1 vs 72.4 ± 10.2） and comorbid cardiovascular disease（50.0% vs 40.8%）; comparison of laboratory tests between two groups: 24-hour urine volume（818.2 ± 155.3 vs 1206.1 ± 197.8）, hemoglobin（76.5 ± 16.5 vs 84.7 ± 17.2）, albumin （28.8 ± 4.9 vs 34.3 ± 5.6） and C-reactive protein 29.7（7.8, 46.6） vs 10.3（1.9, 25.8） with statistically significant differences （P＜0.05）. Logistic regression analysis indicated that age ＞60 years （OR =1.647, 95%CI 1.154-6.925）, comorbid cardiovascular disease （OR= 2.573, 95%CI 1.214-8.352） and number of symptom clusters ＞3 （OR=2.715, 95%CI 1.396-6.937）were risk factors for death. Inclusion in CKD management （OR=0.894, 95%CI 0.412-0.973）, 24-hour urine output ＞800 mL（OR=0.878, 95%CI 0.358-0.953）and albumin ＞30 g/L （OR=0.926, 95%CI 0.508-0.966）were protective factors for death in CKD patients during peri-dialysis period.
Conclusions CKD patients with during peri-dialysis period are at a higher risk of death. Incorporating CKD management, protecting residual urine volume and improving low protein status may help to improve patient survival.

HTML全文

参考文献(17)

施引文献

资源附件(0)