Chinese General Practice ›› 2022, Vol. 25 ›› Issue (21): 2582-2588.DOI: 10.12114/j.issn.1007-9572.2022.0071

• Original Research • Previous Articles     Next Articles

Analysis of New Cases of Hemodialysis in a Single Center in Recent Five Years

  

  1. 1. Department of Nephrology, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, China
    2. Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, China
  • Received:2022-01-17 Revised:2022-03-01 Published:2022-07-20 Online:2022-05-12
  • Contact: Qishun WU
  • About author:
    WU Q S, HE J Q, WANG T N, et al. Analysis of new cases of hemodialysis in a single center in recent five years[J]. Chinese General Practice, 2022, 25 (21) : 2582-2588.

单中心近五年新增首次血液透析患者流行病学特征研究

  

  1. 1.212000 江苏省镇江市,江苏大学附属医院肾脏内科
    2.212000 江苏省镇江市,江苏大学附属医院心内科
  • 通讯作者: 吴其顺
  • 作者简介:
    吴其顺,何建强,王泰娜,等.单中心近五年新增首次血液透析患者流行病学特征研究[J].中国全科医学,2022,25(21):2582-2588. [www.chinagp.net] 作者贡献:吴其顺进行研究设计与实施、资料收集整理、撰写论文并对文章整体负责;吴其顺、何建强、王泰娜、夏炎、余姝进行研究实施、评估、资料收集;吴其顺、何建强、王琳进行质量控制及审校。
  • 基金资助:
    国家自然科学基金青年基金项目(81801664)

Abstract:

Background

Hemodialysis (HD) is one of the most important therapy options for people with end-stage renal disease (ESRD) . ESRD patients require long-term dialysis, which brings a huge burden to society and families. Therefore, a deep understanding of the epidemiological characteristics and changing trends of hemodialysis patients is the key to prevention and treatment.

Objective

To investigate the 662 new first-time HD patients admitted to our center between 2016 and 2020, as well as dialysis patient trends in our center, in order to provide a basis for further improving dialysis quality and prognosis.

Methods

The primary disease data of newly added HD patients in the blood purification center of Affiliated Hospital of Jiangsu University from 2016 to 2020 were retrospectively analyzed according to factors such as year, gender, age, cause of first visit, primary disease, selection of primary vascular pathway and long-term vascular pathway, and death causes of dialysis patients in the previous year.

Results

(1) There were 662 new HD patients, with a male to female ratio of 1.38:1. (2) Newly added HD patients >40 years old accounted for 90.0%, and patients aged 61-70 accounted for the highest proportion of 28.1%. (3) The top three main illnesses among HD patients were diabetic kidney disease (DKD) , chronic glomerulonephritis (CGN) , and hypertensive nephropathy (HN) ; the primary disease of HD patients aged 21~40 was mainly CGN, the primary disease aged 41~70 was mainly DKD, and the primary disease aged 41~70 were mainly DKD and HN. (4) Non-tunneled catheters (NTC) accounted for 76.9% (509/662) ; arteriovenous fistulas (AVF) accounted for 19.9% (132/662) ; and after admission, 82.1% (256/312) patients chose AVF and 9.0% (28/312) patients chose dialysis catheters (TCC) with tunnel and polyester sleeve. (5) Renal anemia, renal hypertension, digestive tract symptoms, metabolic acidosis, heart failure, and other cardiovascular events are the most common complications, accounting for 100.0% (662/662) , 77.0% (510/662) , 66.2% (438/662) , 50.2% (332/662) and 43.2% (286/662) respectively. (6) After one year, 96.8% (641/662) of the patients survived, with the annual proportion of patients who gave up and died decreasing year by year; the annual proportion of patients who chose kidney transplantation and switched to peritoneal dialysis fluctuated slightly; cardiovascular and cerebrovascular events were the main cause of death within one year of follow-up.

Conclusion

From 2016 to 2020, the majority of new primary HD patients in our center are middle-aged and elderly, with males having a higher prevalence rate than females. DKD, CGN, and HN are the most common causes of ESRD, with DKD and HN onset ages older than CGN. NTC is still the main vascular access for primary dialysis. Renal anemia, renal hypertension, gastrointestinal symptoms, metabolic acidosis, heart failure and other cardiovascular events are the main complications of primary HD patients. Patients' awareness of seeking medical treatment and nephrologists' continuous education should be improved in order to achieve the timely establishment of long-term vascular access for patients and timely dialysis treatment. Simultaneously, the possibility of cardiovascular and cerebrovascular events in male DKD patients with high new age of HD needs attention, and intervention measures should be taken to reduce their mortality.

Key words: Kindney diseases, Hemodialysis, Diabetic nephropathies, Vascular access devices, Renal replacement therapy, Primary disease

摘要:

背景

血液透析(HD)是终末期肾脏病(ESRD)患者主要的治疗方法之一,随着HD患者人数逐年增多,如何提高透析质量越来越为临床工作者所重视。ESRD患者需长期透析,给社会、家庭带来巨大负担,因此深入了解HD患者的流行病学特点和变化趋势是预防和治疗的关键。

目的

通过对新增首次HD患者进行分析,旨在探讨HD患者相关变化趋势,从而为进一步提高透析质量和改善患者预后提供依据。

方法

回顾性分析近五年2016—2020年江苏大学附属医院血液净化中心662例新增首次HD患者的原发病资料,按照年份、性别、年龄、首次就诊原因、原发病、首次血管通路及长期血管通路选择、并发症、随访1年内患者死亡原因等因素探讨HD患者相关变化趋势。

结果

(1)新增首次HD患者共计662例,男女比例为1.38∶1。(2)新增首次HD患者中>40岁占90.03%,61~70岁患者占28.1%。(3)新增HD患者原发病前3位分别为糖尿病肾病(DKD)、慢性肾小球肾炎(CGN)和高血压肾病(HN);21~40岁HD患者原发病以CGN为主;41~70岁HD患者原发病以DKD为主;≥71岁HD患者原发病以DKD、HN为主。(4)首次血管通路中,非隧道导管(NTC)占76.9%(509/662);自体动静脉内瘘(AVF)占19.9%(132/662);入院后进一步选择AVF的患者占82.1%(256/312);带隧道和涤纶套的透析导管(TCC)置管占9.0%(28/312)。(5)常见并发症为肾性贫血100.0%(662/662)、肾性高血压77.0%(510/662)、消化道症状66.2%(438/662)、代谢性酸中毒50.2%(332/662)、心力衰竭及其他心血管事件43.2%(286/662)。(6)随访1年内96.8%(641/662)患者存活,放弃与死亡患者年度占比减少;选择肾移植及改行腹膜透析患者年度占比略有波动;心脑血管事件是随访1年内主要的死亡原因。

结论

本中心2016—2020年新增首次HD患者以中老年为主,男性患病率高于女性;DKD、CGN及HN是ESRD主要发病原因,且DKD、HN发病年龄较CGN大,NTC仍是初次透析的主要血管通路,肾性贫血、肾性高血压、消化道症状、代谢性酸中毒、心力衰竭及其他心血管事件是新增首次HD患者主要并发症。应加强患者的就医意识及对肾脏专科医师的继续教育,以期达到患者适时建立长期血管通路、适时透析治疗的目的。同时关注新增HD年龄偏高的男性DKD患者心脑血管事件的发生风险,积极采取干预措施,降低其死亡率。

关键词: 肾疾病, 血液透析, 糖尿病肾病, 血管通路装置, 肾替代疗法, 原发病