Analysis of risk factors for repeated hospitalization and death in newly increased elderly hemodialysis patients
GENG Lei1 WU Weihua1 HUANG Chaoyue1 LIU Jian1,2
1.Department of Kidney Disease of Internal, the Affiliated Hospital of Southwest Medical University Sichuan Clinical Medical Research Center for Kidney Disease, Sichuan Province, Luzhou 646000, China;
2.Department of Kidney Disease of Internal, the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Sichuan Province, Luzhou 646000, China
Abstract：Objective To explore the risk factors of repeated hospitalization in the first year after starting dialysis and its correlation with long-term death in new elderly hemodialysis patients. Methods From July 2013 to June 2018, 166 patients aged ≥60 years old who started dialysis treatment in the hemodialysis room of the Affiliated Hospital of Southwest Medical University were screened out. According to the frequency of hospitalization in the first year after the start of regular dialysis, the patients were divided into non-hospitalization group (57 cases), hospitalization for 1-2 times (71 cases), hospitalization for 3 times or more (38 cases). The laboratory data, complications, all-cause mortality, etc. of patients in the three groups before starting dialysis were compared, and the orderly logistic regression model and COX regression model were respectively used to explore the hospitalization frequency and risk factors of death of the patients. Results A total of 242 hospitalizations were made in 166 patients in the first year after the start of dialysis, with 58 deaths due to all causes by June 2019. The main causes of hospitalization were infectious diseases, cardiovascular events and complications related to vascular access. The main causes of death were cardiovascular events, severe infections and cerebrovascular accidents. Multivariate logistic regression analysis showed that old age, low immunoreactive parathyroid hormone (iPTH), high B natriuretic peptide (BNP), low albumin and low hemoglobin were associated with increased hospitalization risk (P ＜ 0.05), and COX regression analysis showed that hospitalization frequency, low iPTH, high BNP and low albumin were risk factors for death of patients in the first year after the start of dialysis (P ＜ 0.05). Conclusion Low iPTH, low proteinemia and high BNP before dialysis are risk factors for hospitalization and long-term death of patients.
[1] Saran R，Robinson B，Kevin C，et al. US Renal Data System 2016 Annual Data Report：Epidemiology of Kidney Disease in the United States [J]. Am J Kidney Dis，2017，69（3 Suppl 1）：A7-A8.
[2] Masakane I，Nakai S，Ogata S，et al. An Overview of Regular Dialysis Treatment in Japan（As of 31 December 2013） [J]. Ther Apher Dial，2015，19（6）：540-574.
[3] 赵德龙.维持性血液透析患者流行病学调查及生存预后相关性分析[D].北京：中国人民解放军医学院，2016.
[4] 张晓玲，白久旭，郝峻烽，等.老年维持性血液透析患者血管钙化与透析间低血压的相关性研究[J].中华保健医学杂志，2017，19（6）：492-495.
[5] 喻业安，古力尼沙·艾塔弘，李相友，等.维持性血液透析患者住院原因及相关因素分析[J].新疆医学，2015，45（1）：17-20，25.
[6] 葛均波，徐永健，王辰.内科学[M].9版.北京：人民卫生出版社，2018：518.
[7] Kopple JD. National Kidney Foundation K/DOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure [J]. American Journal of Kidney Diseases，Am J Kidney Dis.2001，37（1 Suppl 2）：S66-S70.
[8] Pupim LB，Ikizler TA. Uremic Malnutrition：New insights into an Old Problem [J]. Semin Dial，2003，16（3）：224-232.
[9] Chan KE，Lazarus JM，Wingard RL，et al. Association between Repeat Hospitalization and Early Intervention in Dialysis Patients Following Hospital Discharge [J]. Kidney Int，2009，76（3）：331-341.
[10] Ishii H，Takahashi H，Ito Y，et al. The Association of Ankle Brachial Index，Protein-energy Wasting，and Inflammation Status with Cardiovascular Mortality in Patients on Chronic Hemodialysis [J]. Nutrients，2017，9（4）：pii: E416.
[11] Harel Z，Wald R，Mcarthur E，et al. Rehospitalizations and Emergency Department Visits after Hospital Discharge in Patients Receiving Maintenance Hemodialysis [J]. J Am Soc Nephrol，2015，26（12）：3141-3150.
[12] Antlanger M，Aschauer S，Kopecky C，et al. Heart Failure with Preserved and Reduced Ejection Fraction in Hemodialysis Patients：Prevalence，Disease Prediction and Prognosis [J]. Kidney Blood Press Res，2017，42（1）：165-176.
[13] Ishii J，Takahashi H，Kitagawa F，et al. Multimarker Approach to Risk Stratification for Long-term Mortality in Patients on Chronic Hemodialysis [J]. Circ J，2015，79（3）：656-663.
[14] Assimon M，Wang L，Flythe JE. Failed Target Weight Achievement Associates with Short-Term Hospital Encounters among Individuals Receiving Maintenance Hemodialysis [J]. J Am Soc Nephrol，2018，29（8）：2178-2188.
[15] Movilli E，Camerini C，Gaggia P，et al. Magnitude of End-Dialysis Overweight is Associated with All-Cause and Cardiovascular Mortality：A 3-Year Prospective Study [J]. Am J Nephrol，2013，37（4）：370-377.
[16] Fernandez-Martin JL，Martinez-Camblor P，Dionisi MP，et al. Improvement of Mineral and Bone Metabolism Markers is Associated with Better Survival in Haemodialysis Patients：the COSMOS study [J]. Nephrol Dial Transplant，2015，30（9）：1542-1551.
[17] Tentori F，Wang M，Bieber BA，et al. Recent Changes in Therapeutic Approaches and Association with Outcomes among Patients with Secondary Hyperparathyroidism on Chronic Hemodialysis：the DOPPS Study [J]. J Am Soc Nephrol，2015，10（1）：98-109.
[18] Fouque D，Roth H，Pelletier S，et al. Control of Mineral Metabolism and Bone Disease in Haemodialsysis Patients：Which Optimal Targets？[J]. Nephrol Dial Transplant，2013，28（2）：360-367.
[19] Lin YC，Lin YC，Hsu CY，et al. Effect Modifying Role of Serum Calcium on Mortality-Predictability of PTH and Alkaline Phosphatase in Hemodialysis Patients：An Investigation Using Data from the Taiwan Renal Registry Data System from 2005 to 2012 [J]. PLoS One，2015，10（6）：e0129737.
[20] Nishiwaki H，Hasegawa T，Koiwa F，et al. The Association of the Difference in Hemoglobin Levels before and after Hemodialysis with the risk of 1-year Mortality in Patients Undergoing Hemodialysis.Results from a Nationwide Cohort Study of the Japanese Renal Data Registry [J]. PLoS One，2019，14（1）：e0210533.
2020, Vol. 17 
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