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透析方式和患者结局

Authors
Lionel U Mailloux, MD, FACP
John M Burkart, MD
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD
Translators
王金泉, 主任医师，教授

引言

尽管透析患者的全因死亡率仍高于一般人群，但自20世纪60年代透析技术引入以来，终末期肾病(end-stage renal disease, ESRD)患者的期望寿命已逐渐延长。根据2013年美国肾脏病数据系统(United States Renal Data System, USRDS)报告显示，在1998年开始的患者队列中，所有患者自治疗第1日起测量的校正60月生存概率为0.30，而自2006年开始的患者队列中为0.36[1]。

在过去，美国透析患者生存率较低的部分原因被认为是透析不充分，因为在日本和欧洲，透析患者生存率明显较高，甚至是在病例调整年龄、性别和肾脏诊断后[2]。而日本透析患者共存疾病的危险因素比美国透析患者的少得多[3,4]。然而，其他一些因素更可能是美国透析患者死亡率较高的原因，例如年龄较大、糖尿病患病率较高、共存疾病更多，以及未能准确判断任何明显的共存疾病的严重程度[5]。这一点在美国实现透析剂量增加的情况下尤其正确[5]。

据报道，透析患者生存率最高的地区之一是法国塔桑(Tassin)，该地区的患者每周透析24小时，比几乎所有其他透析中心的时间长得多(图 1)[6]。依据这一结果和其他观察结果，在美国，医生为患者所安排的透析时间普遍增加。

除了增加透析的持续时间，已提出其他因素也可能会改善患者结局。 (参见“开具血液透析处方和评估血液透析的充分性”)

本专题将总结透析方式的选择，以及与特定透析方式相关的患者结局。与透析充分性相关的患者结局、每日血液透析或夜间血液透析的应用，以及不同类型腹膜透析的选择将在别处讨论。 (参见“患者存活期和维持性透析”和“Short daily hemodialysis”和“持续低效或延长每日血液透析”和“夜间血液透析的结局”和“长期腹膜透析方式的选择”)

        

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Literature review current through: 2017-06 . | This topic last updated: 2016-11-04.
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