中国血液净化

›› 2007, Vol. 6 ›› Issue (5): 242-245.

• 论著 • 上一篇    下一篇

非糖尿病性终末期肾病患者透析时机的变化 --2001年和2006年的比较

刘 莉1 杨 莉1 王 梅2   

  1. 1. 100034 北京，北京大学第一医院肾内科 2. 100044 北京大学人民医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2007-05-12 发布日期:2007-05-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2007-05-12 Published:2007-05-12

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摘要： 目的 评估目前终末期肾病(end stage renal disease,ESRD)患者的透析时机，并与5年前比较，探讨过晚透析可能的影响因素及进一步的改进措施。方法 以2000年1月1日～2001年12月31日(A组)和2005年9月1日～2006年8月31日(B组)于北京大学第一医院透析中心开始透析治疗的所有非糖尿病性ESRD患者为研究对象，收集患者开始透析时的肾功能(以简化MDRD公式计算估测的肾小球滤过率，eGFR)、尿毒症并发症以及急诊透析的情况。分析过晚透析的影响因素。结果 ①B组患者的透析时机较A组有一定改善，表现在开始透析时eGFR水平呈明显升高趋势，代谢性酸中毒状况改善。 但血白蛋白水平、尿毒症相关的心脑血管并发症和急诊透析的比例差异没有显著性；②过晚透析患者的贫血更严重，低血钙、高血磷更明显，急诊透析的比例增加，住院时间延长，花费增多；③与A组患者相比，B组患者过晚透析的比例明显下降(P＜0.05)，但两组患者过晚透析的原因差异没有显著性，仍然以不知自己患有肾脏病或肾衰竭占首位(73.92%)。结论 慢性肾脏病和肾衰竭发现过晚仍是过晚透析的主要影响因素，加强公众宣传、肾脏病筛查以及对肾脏专科医师的继续教育有望使更多的患者能适时开始透析。

关键词: 终末期肾病, 透析时机, 肾小球滤过率, 尿毒症并发症

Abstract: Objective To evaluate the appropriate time for the beginning of dialysis in end stage renal disease (ESRD), we compared the clinical status at the beginning of dialysis in the patients in 2006 with those in 2001. The causes of delayed dialysis and the measures for change of this situation were discussed. Methods Patients of non-diabetic ESRD in this hospital regularly treated with dialysis starting in the periods of Jan. 1 to Dec. 31, 2001 (group A) and Sept. 1, 2005 to Aug. 31, 2006 (group B) were analyzed. Before dialysis treatment their residual renal function presented as estimated glomerular filtration rate (eGFR) from the simplified MDRD equation, uremia complications and the patients treated with emergent dialysis were collected. Results ①eGFR was higher in group B than in group A (5.95mL/min/1.73m2 vs. 5.23mL/min/1.73m2, P<0.05), and the metabolic acidosis was also less severe in group B. Serum albumin, uremia-related cerebro- cardiovascular complications and the number of patients required emergent dialysis were similar between the 2 groups. ② Patients of delayed dialysis usually showed severe anemia, lower serum calcium and higher serum phosphate, and spent more money for the longer hospitalization. More of them required emergent dialysis. ③ The number of delayed dialysis decreased dramatically in group B (P<0.05, as compared with that of group A). On the other hand, the unawareness of having renal diseases and renal failure was the main cause of delayed dialysis (73.92%) in the 2 groups. Conclusions Delayed diagnosis of chronic kidney diseases and chronic renal failure caused the delay of dialysis. Health education, screening of renal diseases in population and re-education for nephrologists are the important measures for the improvement of this situation.

Key words: Time for initiation of dialysis, Glomerular filtration rate, Uremic complications

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