中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (06): 394-396.doi: 10.3969/j.issn.1671-4091.2019.06.005

• 临床研究 • 上一篇    下一篇

终末期肾病患者首次血液透析情况的研究

余姝1,朱文芳1,巢军1,吴其顺1,夏炎1,何建强1   

  1. 1. 江苏大学附属医院肾内科
  • 收稿日期:2018-12-06 修回日期:2019-03-25 出版日期:2019-06-12 发布日期:2019-06-12
  • 通讯作者: 何建强 hejq0305@163.com E-mail:hejq0305@aliyun.com

Clinical characteristics at the initiation of hemodialysis of end stage renal disease patients

  • Received:2018-12-06 Revised:2019-03-25 Online:2019-06-12 Published:2019-06-12

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摘要： 【摘要】目的了解终末期肾病(end stage renal diease，ESRD)患者首次透析时临床情况差异，为持续改进透析前慢性肾脏病(chronic kidney disease,CKD)管理提供依据。方法采用单中心的回顾性研究，纳入2015 年3 月～2018 年8 月在江苏大学附属医院进行首次血液透析(hemodialysis，HD)的ESRD 患者272 例，其中糖尿病肾病(diabetic nephropathy,DN)患者120 例为DN 组，非DN 患者152 例为非DN 组，了解这些患者进入HD 时的临床情况，并比较2 组患者首次HD 时的原因、透析通路及进入透析时实验室指标的差异。结果DN 组透析前CKD 门诊就诊人数明显多于非DN 组(t=14.777,P＜0.001)。2组患者进入HD时的直接原因，DN组患者以心力衰竭为主，非DN组患者以尿毒症症状为主。进入HD时DN组血红蛋白、肾小球滤过率明显高于非DN组(t 值分别为3.190,7.155；P 值分别为0.002，＜0.001)，血尿素氮、血肌酐、血磷和全段甲状旁腺激素水平明显低于非DN 组(t 值分别为-5.736,-8.231，-3.785，-3.116；P 值分别为＜0.001，＜0.001，＜0.001，0.002)。首次血液透析时2 组在血管通路选择方式比较上有统计学差异(χ2=4.917，P =0.027)。结论DN 为本中心近3 年新发终末期肾病血液透析患者首位
原发病因。DN 患者进入血液透析时的估算肾小球滤过率(estimated glomerular filtration rate，eGFR)相对较高，心力衰竭是DN 患者进行首次血液透析最常见原因。首次血液透析时血管通路中心静脉导管使用比例很高，需要进一步加强透析前慢性肾脏病门诊的管理，提高计划性动静脉内瘘建立的比例，降低中心静脉插管的比例。

关键词: 糖尿病肾病, 首次血液透析, 慢性肾脏病

Abstract: 【Abstract】Objective To investigate the differences of clinical characteristics at the initiation of hemodialysis of end-stage renal disease (ESRD) patients in order to obtain the information relating to continuous improvement of management of pre- dialysis chronic kidney disease (CKD) patients. Methods This was a retrospective single center study. A total of 272 ESRD patients beginning hemodialysis at the Affiliated Hospital of Jiangsu University between March 2015 and August 2018 were recruited. They were divided into diabetic nephropathy group (DN group, n=120) and non-DN group (n=152). The main cause directly leading to dialysis, vascular access and laboratory parameters were compared between the two groups. Results Before dialysis, more outpatients were found in DN group than in non-DN group (P＜0.001). The main cause directly leading to the initiation of hemodialysis was heart failure/edema in DN group and was uremic symptoms in non-DN group. In DN group, hemoglobin and eGFR were higher than in non-DN group (t=3.190 and 7.155; P=0.002 and ＜0.001), and blood urea nitrogen, serum creatinine, serum phosphorus and iPTH were lower than in non-DN group (t=- 5.736, - 8.231, - 3.785 and - 3.116 respectively; P=＜0.001, ＜0.001, ＜0.001 and 0.002 respectively). The implement of blood access was significant different between the two groups (χ2=
4.917, P=0.027). Conclusions DN was the first primary cause for initiating hemodialysis in ESRD patients in the past 3 years. DN patients initiated hemodialysis earlier and often due to refractory heart failure. The use of central vein catheterization for blood access was higher during the initiation of hemodialysis. Therefore, clinical management of CKD patients at the outpatient department should be reinforced. In addition, arteriovenous fistula operation should be considered before initiating hemodialysis to decrease the temporary vascular catheterization.

Key words: diabetic nephropathy, initiating hemodialysis, chronic kidney disease