中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (02): 89-93.doi: 10.3969/j.issn.1671-4091.2022.02.005

• 临床研究 • 上一篇    下一篇

中国血液透析患者死亡原因及特点分析-DOPPS 研究的启示

赵新菊1,甘良英1,牛庆雨1,陈育青2,侯凡凡3,倪兆慧4,陈晓农5,梁馨苓6,左力1   

  1. 1北京大学人民医院肾内科
    2北京大学第一医院肾内科
    3南方医科大学南方医院肾内科
    4上海交通大学仁济医院肾内科
    5上海交通大学瑞金医院肾内科
    6广东省医学科学院广东省人民医院肾内科

  • 收稿日期:2021-11-18 修回日期:2021-11-30 出版日期:2022-02-12 发布日期:2022-02-17
  • 通讯作者: 左力 zuoli@bjmu.edu.cn E-mail:zxjrmyy@163.com
  • 基金资助:
    国家自然科学基金(81870524)

The cause of death and its related information in hemodialysis patients in China - enlightenment from the DOPPS study

  1. 1Department of Nephrology, Peking University People’s Hospital, Beijing 100044, China;  2Department of Nephrology, Peking University First Hospital, Beijing 100034, China;  3Department of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou 510515, China;  4Department of Nephrology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China; 5Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China; 6Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
  • Received:2021-11-18 Revised:2021-11-30 Online:2022-02-12 Published:2022-02-17

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摘要： 【摘要】虽然血液透析(hemodialysis,HD)治疗可以提高终末期肾病(end stage renal disease，ESRD)患者的预期寿命，但是与普通人群相比，透析患者死亡风险仍然显著增加。本研究旨在探究中国透析预后与实践模式研究(Dialysis Outcomes and Practice Patterns Study, DOPPS)中HD 患者死亡原因及死亡特点。方法DOPPS 是1 项国际性的前瞻性观察研究，中国参加了DOPPS 5 期研究(2012～2015 年)，并完成了队列的随访。中国DOPPS 5 中纳入了1427 名患者。以这些患者为研究对象，收集人口统计学、实验室检查、死亡日期、死亡原因等指标。明确患者死亡原因及死亡时间、地点等特点。结果DOPPS 5 期研究中共纳入1427 名HD 患者，其中北京473例，广州454例，上海500例。患者平均年龄为(59.4±14.9)岁，男性占55.0%，糖尿病患者占25.1%。平均随访时间为1.9 (1.1, 2.1)年。在随访期间共205名患者发生死亡，患者总体死亡率为14.4%，年平均死亡率为8.8%。死亡患者的中位年龄为70(59,79)岁；男性比例为56.1%，中位透析龄为2.5(1.0～5.0)年。北京、广州、上海死亡患者数分别为67, 67, 71 例，年平均死亡率分别为7.9%，10.0%以及8.6%。导致HD 患者死亡的前3 位病因分别为：脑血管意外(含缺血性卒中，19.3%)、充血性心力衰竭(18.2%)和肺部感染(11.6%)。心血管死亡总计为105 例，占51.2%。主要死亡原因排序有性别差异。血液透析死亡患者中70.8%于医院死亡，27.0%患者在家中发生死亡；79.8%患者没有停止血液透析，20.2%患者死亡前停止了HD 治疗。死亡患者中高达62.9%患者在死
亡前接受了临终关怀治疗。1天中10pm～6am 时段患者死亡风险最高。结论在中国DOPPS 5 期研究中，患者年平均死亡率为8.8%，其中心血管死亡是最主要的原因。在单项死亡原因中脑血管意外(含缺血性卒中)、充血性心力衰竭和肺部感染为最常见的3 种病因，且死亡的病因似乎具有性别差异。大部分患者为可预见的临终状态，1/4 的患者在家中死亡，在无医疗干预情况下，患者夜间凌晨死亡风险最高。

关键词: 血液透析, 死亡, 临终关怀, 透析预后与实践模式研究

Abstract: 【Abstract】Although hemodialysis (HD) can improve the life expectancy of end stage renal disease (ESRD) patients, the risk of death is still significantly higher in HD patients than in general population. The purpose of this study was to explore the cause of death and its related information in HD patients in the China Dialysis Outcomes and Practice Patterns Study (DOPPS). Methods DOPPS is an international, prospective and observational study. China participated in the DOPPS 5 study (2012～2015) and has completed the follow-up of the cohort. A total of 1,427 patients were enrolled in the China DOPPS 5 study. Their demographics,
primary cause of ESKD, comorbidities, dialysis prescription, laboratory examination results, and date, cause and other related information of death were recruited. The primary cause, date and place of death were then defined. Results A total of 1,427 HD patients were enrolled in the China DOPPS 5 study, including 473 cases in Beijing, 454 cases in Guangzhou and 500 cases in Shanghai. The average age of the patients was 59.4+14.9 years old, 55% were males, and 25.1% had diabetes. The mean follow-up period was 1.9 years (1.1, 2.1 years). During the follow-up period, 205 patients died, with the overall mortality of 14.4% and the annual average mortality of 8.8%. In the death patients, the median age was 70 (59, 79) years old, 56.1% were males, and the median dialysis vintage was 2.5 (1.0～5.0) years. The number of death patients in Beijing, Guangzhou and Shanghai were 67, 67 and 71 cases respectively, with the annual average mortality of 7.9%,10.0% and 8.6% respectively. The top three causes of death in HD patients were cerebrovascular events (19.3%, including ischemic stroke), congestive heart failure (18.2%) and pulmonary infection (11.6%); 105 cases died of cardiovascular diseases, accounting for 51.2% of the death patients. There were gender differences in the ranking of the main causes of death. In the died patients, 70.8% died in hospital and 27.0% died at home; HD treatment continued before death in 79.8% patients, and discontinued before death in 20.2%; 62.9% cases received
hospice care before death; the risk time of death in a day was within 10pm～6am. Conclusion In the China DOPPS 5 study, the average annual mortality was 8.8%. The main cause of death was cardiovascular events. Among the single cause of death, cerebrovascular events (including ischemic stroke), congestive heart failure and pulmonary infection were the most common causes of death, and the causes of death seemed to be gender different. The terminal stage was present in most death patients, and 1/4 of death happened at home. Without medical intervention, the risk time of death in a day was from late night to early morning.

Key words: Hemodialysis, Mortality, Hospice care, DOPPS

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