关键词: 维持性血液透析, 血管通路, 死亡原因, 生存率, 流行病学

Abstract: 【Abstract】Objective To obtain the data supporting standardized treatment and continuously improving the quality of hemodialysis, we investigated the current treatment status and epidemiology of maintenance hemodialysis (MHD) patients in our hemodialysis center. Methods We retrospectively reviewed the clinical records of 513 MHD patients treated for more than 3 months in the Blood Purification Center, the Second Hospital of Shanxi Medical University between Jan. 2010 and Dec. 2014. Gender, onset age, medical expense type, primary renal disease, the first vascular access type, complications, changes of treatment, cause of death, and survival rate were analyzed. All related data were collected through the Chinese National Renal Data System. Results ①In our hemodialysis center, the number of hemodialysis patients increased annually. Among the 513 MHD patients, 291 were males and 222 were females with a male/female ratio of 1.3 to 1. ②Most patients with end stage renal disease (ESRD) were in the age of 40 to 49 years and 50 to 59 years. ③In the 431 patients with defined causes of ESRD, the top 3 primary causes were glomerulonephritis (48.0%), diabetic nephropathy (25.9%), and hypertensive nephrosclerosis (10.7%). ④The first used vascular access at the beginning of hemodialysis was temporary central venous catheter (76.8% ), and primary arteriovenous fistula (21.5%). ⑤Anemia was the most common complication, followed by hypertension, bone and mineral disorders. The rates achieved to the recommended levels of hemoglobin, blood pressure, blood calcium, blood phosphorus and IPTH were less than 50%. ⑥Among 513 MHD patients, 12 received renal transplantation, 11 changed to peritoneal dialysis, 385 transferred to other hospitals for hemodialysis, 5 got rid of dialysis, 9 gave up the treatment, 24 died, and 67 were still hospitalized in our unit. Cardiovascular and cerebrovascular incidences were the leading causes of death. ⑦The survival rate of MHD patients was different: 93.3% in one
year, 75.3% in five years, 14.6% in ten years, and one for more than 228 months and still under regular dialysis. Conclusion In our dialysis center, the majority of the MHD patients were middle aged and elderly males. The first three primary causes leading to ESRD were glomerulonephritis, diabetic nephropathy, and hypertensive nephrosclerosis. The major vascular access at the beginning of hemodialysis was temporary central venous catheter, suggesting that timely hemodialysis should be emphasized. The incidence rate of anemia, hypertension, bone and mineral disorders were high, but the control rates were low. Cardiovascular and cerebrovascular incidences were the leading cause of death. As the hemodialysis treatment was prolonged, the longterm survival rate of MHD patients was gradually reduced.

Key words: Maintenance hemodialysis, Vascular access, Cause of death, Survival rate, Epidemiology