| Objective：End-stage Renal Disease (ESRD) is the final development stages of Chronic kidneyDisease (CKD), is a syndrome that caused by different kidney damage etiology andprogressive deterioration. At present, China ESRD etiology situation is unclear, still needmulti-region, multi hemodialysis centers large sample epidemiological investigation. Tounderstand the etiology constitutes, complications, therapeutic methods, medical costs andquality of life of the patients with end-stage renal disease(ESRD) undergoing maintenancehemodialysis in Guiyang city, in order to promote dialysis treatment standardization andcontinuous quality improvement, is critical to formulate the corresponding prevention andcontrol strategies in medical practice, at the same time,it can also provide data morereasonable to arrange the allocation of health resources for administrative department ofpublic health.Therefore, to explore and establish Guiyang maintain hemodialysis in patientswith epidemiological data and database is a pressing research task.Method：Regular dialysis ESRD cases were collected from12hemodialysis centers in Guiyangbased on medical records, information gathering including general characteristics, distanceof residence, primary disease, complications,and drug therapy, dialysis frequency, mode ofdialysis, dialysis time per week, medical costs, medical insurance pattern, the hemodialysisadequacy, quality of life, etc. and the above informations distribution characteristics weredescribed.Results：1. In756ESRD with hemodialysis patients, from2011to2012, the ratio of male tofemale was1.4:1, average age was (49.1±14.7) years old, education level of college degree or equivalent was135cases (17.9%). The top five disease etiologies wererespectively chronic glomerular nephritis (407cases,53.8%), diabetic nephropathy(132cases,17.5%), hypertensive renal injury (124cases,16.4%), polycystic kidney disease(28cases,3.7%), drug-induced renal damage (13cases,1.7%); Hemodialysis vascularaccess：466cases (61.6%) were accepted internal arteriovenous fistula,243cases(32.1%)were long-term central venous catheter,33cases (4.4%) were transplantationvascular fistula,12cases (1.6%) were direct puncture and2cases (0.3%) were long-termfemoral vein catheters.2. Complications and related treatment:496case（s65.6%）suffered from cardiovasculardisease complications,271cases (35.9%) with hemoglobin reached normal level,747cases(98.8%) used erythropoietin (EPO), only273cases (36.1%) used iron and364cases (48.2%)used folic acid to treat renal anemia.354cases (46.8%) were up to blood phosphorusstandard and123cases (16.2%) to intact parathyroid hormone standard.3. Medical expense situation: The average monthly total medical costs were RMB6072.6±3381.1.95.51%of ESRD hemodialysis patients had medical insurance, insurancemodel including the municipal, provincial insurance and agricultural insurance,themunicipal medical insurance as the leading factor, accounted for72.75%; full fee-payingpatients came to4.49%; Patients family annual income per capita mainly3to5tenthousand, accounting for58.07%.64.81%of patients thought that hemodialysis’s medicalexpenses had bigger impact on family economy and standard of living. Compared withmunicipal insurance group and provincial insurance group, hemoperfusion treatment timeper week, patients in rural cooperative medical insurance group and full fee-paying groupwere significantly lower (P<0.05). The dialysis times per week, hemodialysis andhemofiltration treatment time, patients in full fee-paying group were evidently reduced, bycontrast to other three groups(P<0.05).4. Hemodialysis patients with chronic glomerulonephritis in the third-grade class-Ahospital HD patients with kidney disease and dialysis-related quality of life in eachdimension score had significant difference in term of different dialysis duration (P<0.05).The patients whose hemodialysis duration greater than60months got the lower scores inquality of life and the general health-related quality of life.5. In the third-grade class-A hospital,89HD patient（s51.74%）that primary disease was chronic glomerulonephritis were suffered from CVD complications,after the multi-factorlogistic regression analysis, there are four factors as the independent risk factors ofcardiovascular complications, the risk from big to small in turn is hypertension, parathyroidhormone levels, distance between residence and the dialysis unit, hyperphosphatemia. Thegroup of the farthest distance(＞30km) has the worst influence on dialysis adequacy Kt/Vscore, urea clearance rate, dialysis frequency and time per week; and the level of bloodphosphorus, triglyceride and cholesterol in the forth group of farthest elevatemarkedly,which has significant positive correlation with distance(P <0.05).Conclusion:1. The main primary disease of patients with ESRD undergoing maintenancehemodialysis in Guiyang City is the chronic glomerulonephritis and the first-line vascularaccess is internal arteriovenous fistula. The qualified rate of complications such as renalanemia, hyperphosphatemia and secondary hyperparathyroidism is lower. Therefore,thetreatment compliance and standardization still needs to be strengthened. Medical insurancecoverage of ESRD hemodialysis patients is higher, and the municipal medical insurance asthe main insurance model. In various modes, patients who self bear heavier economicburden had lower hemodialysis time.2. The research about HD patients with chronic glomerulonephritis in the third-gradeclass-A hospital found that the different dialysis duration with each quality of life aresignificantly different,the patients whose hemodialysis duration＞60months get the lowerscores in quality of life and the general health-related quality of life. Aafter the multi-factorregression analysis, there are four factors as the independent risk factors of cardiovascularcomplications, in order, hypertension, parathyroid hormone levels, distance betweenresidence and the dialysis unit,hyperphosphatemia. Longer distance in patients with lowerdialysis time and adequacy, Some laboratory indexes control condition is not satisfied. |
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