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目的提供我国中等城市终末期肾病(ESRD)患者开始透析时肾功能水平的准确数据并分析相关因素,为选择合适的透析时机提供依据。方法查阅1998年1月至2004年8 月期间长沙市两大透析中心所有首次透析的终末期肾病住院患者的病案,其中514例数据齐全而人选并按不同条件分组。计算整组病例及各分组的平均Scr值、GFR预测值(eGFR)及其他统计指标,以及比较组间差异并与国外资料比较。结果 (1)男性较女性多;45岁以下患者占 50．4％;自费患者最多(55．4％),但比例逐年下降;医保患者占17．7％,而比例则逐年增高; 91．8％的患者选择血液透析为首次治疗方式;首位病因仍是肾小球肾炎(59．7％),其次为高血压肾病(10．9％)和糖尿病肾病(6．8%),肾小球肾炎患者所占比例逐年下降,而高血压和糖尿病患者的比例则逐年增高。(2)平均Scr浓度为(1121．92±458．24)μmol／L;平均eGFR为 (4．98±2．24)ml·min-1·(1．73 m2)-1。(3)年轻人、无费用保障的患者、无业或农民、在职人员、学生、选择血液透析的患者、原发病为非糖尿病的患者中,Scr值较高而eGFR值则较低,组间差异均有统计学意义(P<0．01)。男性患者的Scr和eGFR值均高于女性(P<0．01,P<0．05)。(4) 低白蛋白血症患者占总例数的53．1％。当eGFR<8．4 ml·min-1·(1．73 m2)-1时,eGFR与血清白蛋白(Salb)呈正线性相关(r=0．093,P<0．05)。(3)与美国1999年资料比较,本组514例患者的eGFR预测值低于美国患者(P<0．01)。结论本组以年轻男性患者多见。肾小球肾炎患者所占比例逐年下降,而高血压和糖尿病患者的比例则逐年增高。相当多的患者在肾功能非常差时才开始透析。患者普遍存在低白蛋白血症,eGFR下降到一定水平以后,Salb随eGFR下降而下降。本组514例ESRD患者开始透析的时机要较美国患者晚。
Objective To provide accurate data on the renal function of patients with end-stage renal disease (ESRD) in our country at the start of dialysis and to analyze the related factors, so as to provide the basis for choosing the appropriate timing of dialysis. Methods From January 1998 to August 2004 in Changsha, two dialysis centers were dialysis of patients with end-stage renal disease inpatients, of which 514 cases were complete and the candidates were selected according to different conditions. The mean Scr, GFR predictive value (eGFR) and other statistical indicators of the entire group of patients and their subgroups were calculated, and the differences between the groups were compared and compared with foreign data. Results (1) There were more males than females; 50.4% of patients under 45 years of age; patients with self-paid patients were the most (55.4%), but the proportion decreased year by year; Medicare patients accounted for 17.7%, while the proportion increased year by year; 8% of the patients chose hemodialysis as the first treatment; the first etiology was still glomerulonephritis (59.7%), followed by hypertensive nephropathy (10.9%) and diabetic nephropathy (6.8%), kidney The proportion of patients with chronic glomerulonephritis decreased year by year, while the proportion of patients with hypertension and diabetes increased year by year. (2) The mean Scr concentration was (1121.92 ± 458.24) μmol / L and the mean eGFR was (4.98 ± 2.24) ml · min-1 · (1.73 m2) -1. (3) Among young people, patients without insurance, unemployed or farmers, serving staff, students, patients who choose hemodialysis, patients with non-diabetic primary disease had higher Scr and lower eGFR, The differences were statistically significant (P <0.01). The Scr and eGFR values in male patients were higher than those in women (P <0.01, P <0.05). (4) Hypoalbuminemia accounted for 53.1% of the total cases. When eGFR <8.4 ml · min-1 · (1.73 m2) -1, eGFR was positively correlated with serum albumin (r = 0.093, P <0.05). (3) Compared with the data of the United States in 1999, the predictive value of eGFR in 514 patients in this group was lower than that in American patients (P <0.01). Conclusion This group is more common in young men. The proportion of patients with glomerulonephritis decreased year by year, while the proportion of patients with hypertension and diabetes increased year by year. A significant number of patients start dialysis only when the renal function is very poor. Patients with hypoalbuminemia prevalence, eGFR dropped to a certain level after Salb decreased with eGFR decline. The group of 514 ESRD patients started dialysis later than the United States patients.