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目的分析夜间血液透析(nocturnal hemodialysis,NHD)患者退出的原因并探讨其危险因素。方法收集第二军医大学长征医院2009年2月至2016年11月行NHD满3个月后退出NHD的47例患者和维持NHD的64例患者的临床资料,收集患者一般资料,比较两组患者首次行NHD及末次行NHD时的血红蛋白、血小板、白蛋白、铁蛋白、血钙、血磷、甲状旁腺激素等指标的差异,采用Cox回归模型分析患者退出NHD和死亡的危险因素。结果 47例患者退出NHD,行NHD的平均时间为(31.55±20.30)个月,退出原因分别是死亡、转院、转传统血液透析(CHD)、肾移植及其他。单因素Cox回归分析显示,在原发疾病中,高血压肾病(P=0.007,HR=2.913,95%CI:1.348~6.293)和糖尿病肾病(P=0.047,HR=2.401,95%CI:1.014~5.685)是NHD患者退出的危险因素,慢性肾炎综合征(P<0.001,HR=0.095,95%CI:0.046~0.195)则是保护因素;在血液检测指标中,低白蛋白水平(P=0.007,HR=0.904,95%CI:0.840~0.973)是NHD患者退出的危险因素;高龄(P=0.027,HR=1.052,95%CI:1.006~1.101)是NHD患者退出的危险因素。多因素Cox回归分析显示,低白蛋白水平(P=0.007,HR=0.911,95%CI:0.848~0.991)是NHD患者死亡的独立危险因素。结论高血压肾病和糖尿病肾病是NHD患者退出的危险因素,慢性肾炎综合征是其保护因素。低白蛋白是NHD患者死亡的独立危险因素。
Objective To analyze the causes of nocturnal hemodialysis (NHD) withdrawal and explore its risk factors. Methods The clinical data of 47 patients with NHD and 64 patients with NHD who had withdrawn from NHD 3 months after the NHD from February 2009 to November 2016 in Changzheng Hospital of Second Military Medical University were collected. General data of patients were collected and compared between the two groups NHD and the last line of NHD for the first time, hemoglobin, platelet, albumin, ferritin, serum calcium, phosphorus, parathyroid hormone and other indicators of difference, using Cox regression analysis of patients with NHD and death risk factors. Results The mean time to quit NHD and NHD in 47 patients was (31.55 ± 20.30) months. The reasons for the withdrawal were death, transfer, traditional hemodialysis (CHD), renal transplantation and others. Univariate Cox regression analysis showed that among the primary diseases, the incidences of hypertensive nephropathy (P = 0.007, HR = 2.913, 95% CI: 1.348-6.293) and diabetic nephropathy (P = 0.047, HR = 2.401, 95% CI: ~ 5.685) were the risk factors for the withdrawal of NHD. Chronic nephritic syndrome (P <0.001, HR = 0.095, 95% CI: 0.046-0.1995) was a protective factor. In the blood test, the level of low albumin (P = 0.007, HR = 0.904, 95% CI: 0.840-0.973) were the risk factors for withdrawal from NHD. The elderly (P = 0.027, HR = 1.052, 95% CI: 1.006-1.101) were the risk factors for withdrawal from NHD. Multivariate Cox regression analysis showed that low albumin levels (P = 0.007, HR = 0.911, 95% CI: 0.848-0.991) were independent risk factors for mortality in NHD patients. Conclusion Hypertensive nephropathy and diabetic nephropathy are the risk factors of withdrawal in patients with NHD, and chronic nephritic syndrome is the protective factor. Low albumin is an independent risk factor for death in NHD patients.