References

nid

Нефрология и диализ

Nephrology and Dialysis

1680-44222618-9801

Российское диализное общество

nid-1978

Research Article

ОРИГИНАЛЬНЫЕ СТАТЬИ

ORIGINAL ARTICLES

Предикторы летального исхода у больных на гемодиализе

Mortality predictors in patients undergoing hemodialysis

Бикбов

Б. Т.

Bikbov

B. T.

noemail@neicon.ru

Кирхман

В. В.

Kirchman

V. V.

noemail@neicon.ru

Ушакова

А. И.

Ushakova

A. I.

noemail@neicon.ru

Камшилова

Н. И.

Kamshilova

N. I.

noemail@neicon.ru

Томилина

Н. А.

Tomilina

N. A.

natomil@online.ru

Научно-исследовательский институт трансплантологии и искусственных органов МЗ РФ; ГКБ № 52, Московский городской нефрологический центр, МоскваRussian Federation

2004

27062025

62154163

2025

Бикбов Б.Т., Кирхман В.В., Ушакова А.И., Камшилова Н.И., Томилина Н.А.

Bikbov B.T., Kirchman V.V., Ushakova A.I., Kamshilova N.I., Tomilina N.A.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://journal.nephro.ru/jour/article/view/1978

Выявление предикторов летального исхода имеет большое значение для прогноза исхода лечения гемодиализом (ГД) и выбора оптимальной тактики коррекции этих нарушений у больных на ГД, а также профилактики их развития до начала заместительной почечной терапии. Целью настоящей работы явилось выяснение влияния на выживаемость больных ряда важнейших клинических, биохимических и эхокардиографических показателей, оцененных у пациентов к началу лечения ГД. В ретроспективный анализ были включены 213 больных (исключены больные с диабетической нефропатией), в качестве первого вида заместительной почечной терапии получавших лечение ГД. Длительность лечения ГД составила от 3,5 до 60 месяцев (27,4; 15,6-38,1). Суммарный срок наблюдения составил 479,2 человеко-лет, в течение которого было зафиксировано 43 смерти (20% всех наблюдений), пятилетняя выживаемость больных составила 68,6%, летальность - 9,0/100 пациенто-лет. При однофакторном анализе выявлено, что возраст старше 55 лет, снижение концентрации альбумина менее 35 г/л, высокие значения индекса коморбидности Charlson, наличие ишемической болезни сердца, превышение индекса массы левого желудочка к началу лечения ГД являются предикторами летального исхода. При многофакторном анализе с использованием модели Кокса, включающей все вышеназванные предикторы, наибольший вклад в прогноз летального исхода дают более чем 50% превышение индекса массы левого желудочка по сравнению с нормой (ОР 3,54, 95% ДИ 1,08-11,64) и показатели индекса коморбидности Charlson 5 и выше (ОР 3,59, 95% ДИ 1,19-10,84).

Revealing the predictors of mortality allows one to choose the optimal treatment strategy of hemodialysis (HD) and to make a successful preventive interventions in patients before starting renal replacement therapy. The purpose of this study was to examine the influence of some clinical and laboratory parameters on survival in a group of incident HD patients. To search for risk predictors, a retrospective cohort study was performed with 213 hemodialysis nondiabetic patients. Duration of HD treatment varied from 3,5 to 60 month (median 27,4; interquartile range 15,6-38,1). During follow-up period of 479,2 person-years 43 patients died, 5-year survival was 68,6% and mortality rate was 9,0/100 patient-years. Kaplan-Meier analysis showed that age >55 years, serum albumin <35 g/l, Charlson Comorbidity Index ≥5, prevalent coronary heart disease and increased left ventricular mass index (LVMI) at the start of HD treatment are significant predictors of mortality. Analysis with the Cox model revealed that increasing of LVMI over normal value by more than 50% (RR 3,54, 95% CI 1,08-11,64) and the Charlson Comorbidity Index ≥5 (RR 3,59, 95% CI 1,19-10,84) are independent predictors of mortality.

терминальная ХПНпрограммный гемодиализвыживаемостьиндекс коморбидностигипертрофия миокарда левого желудочкавозрастгипоальбуминемияишемическая болезнь сердца

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The authors declare that there are no conflicts of interest present.