ISSN 1006-298X      CN 32-1425/R

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肾脏病与透析肾移植杂志 ›› 2022, Vol. 31 ›› Issue (6): 519-524.DOI: 10.3969/j.issn.1006-298X.2022.06.004

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2019—2021年单中心血液透析死亡患者流行病学特点分析

  

  • 出版日期:2022-12-28 发布日期:2023-01-04

Epidemiological characteristics of hemodialysis death patients from 2019 to 2021 in a single center

  • Online:2022-12-28 Published:2023-01-04

摘要: 目的:回顾性分析近3年维持性血液透析(MHD)死亡患者的流行病学情况,为提高患者生存质量提供依据。
方法:回顾性收集20190101至20211231登记在海军军医大学第一附属医院肾内科死亡的MHD患者的临床资料,分析原发病构成、年病死率、透析龄,探讨原发病、血钾、血红蛋白、糖尿病病史、透析通路、透析频次等因素对长期生存率的影响。
结果:MHD死亡患者的主要原发病是慢性肾小球肾炎、糖尿病肾脏疾病(DKD)、高血压肾病。2021年原发病为DKD较前两年明显上升,2021年总体年病死率较前两年亦上升。DKD组患者的透析龄最短,透析龄<3年占400%;血钾4~5 mmol/L组的透析龄超过5年占587%;Hb 110~130 g/L组患者的透析龄不足1年的仅占38%。死亡原因主要为心脑血管事件。血磷水平不达标的患者以及患糖尿病的MHD患者生存率较低,经内瘘透析的患者及每周3次透析的患者生存率较高(P<005)。
结论:本中心近3年MHD患者年病死率呈上升趋势,DKD超过慢性肾小球肾炎成为本中心死亡患者第一位的原发病。建立内瘘血管通路、每周规律3次透析,血磷达标可提高患者的生存率。


关键词: 血液透析, 死亡原因, 生存质量

Abstract: Objective:To investigate and analyze the epidemiology of dead patients on maintenance hemodialysis(MHD) in recent 3 years, and provide basis for improving quality of life of patients.
Methodology:The clinical data of MHD patients who died in our hemodialysis center from January 1, 2019 to December 31, 2021 were collected. The primary disease composition, annual mortality and distribution characteristics of dialysis age of the dead patients were analyzed. The dialysis age was compared according to primary disease, blood potassium, diabete history,dialysis access,frequency and hemoglobin.
Results:The main primary causes were chronic glomerulonephritis, diabetic kidney disease and hypertensive nephropathy in the dead patients. The overall annual death rate in 2021 was higher than that in the previous two years. The dialysis age of diabetic kidney disease group was the shortest, 400% of patients who suffered from diabetes nephropathy were less than 3 years of dialysis time; the hemodialysis patients with blood potassium 4~5 mmol/L had a dialysis age of more than 5 years, accounting for 587%; only 38% of the patients in the group of Hb 110~130 g/L had less than one year of dialysis age. In recent three years, the main cause of death of hemodialysis patients was cardiovascular and cerebrovascular events. The survival rate of patients with substandard blood phosphorus levels and patients with a history of diabetes decreased, nevertheless, the survival rate of patients with hemodialysis through internal fistula was significantly higher than other patients, the same as patients with hemodialysis three times a week, and the difference was statistically significant.
Conclusion:The annual mortality MHD patients in our center has increased in recent three years. Diabetic kidney disease has become the first primary cause of death in our center, surpassing chronic glomerulonephritis. The establishment of internal fistula vascular access, regular hemodialysis three times a week, the standard of blood phosphorus and the effective treatment of diabetes can improve the survival rate of hemodialysis patients.

Key words: hemodialysis, cause of death, quality of life