| Objective To investigate the basic situation of maintenance hemodialysis patients in our hospital's hemodialysis room.To compare the general situation,complications and prognosis of diabetic nephropathy and non-diabetic nephropathy patients with uremia maintenance hemodialysis.To analyze the survival rate,causes of death,mortality and risk factors of the two groups,and to understand the general characteristics of diabetic nephropathy patients,so as to formulate targeted hemodialysis treatment programs.Methods According to the primary onset of end-stage renal disease,the patients undergoing long-term hemodialysis in our hospital from July 2007 to June 2014 were divided into diabetic group and non-diabetic group.The age,sex,duration of disease,pre-dialysis hemoglobin,albumin,urine volume,blood sugar,eGFR and serum creatinine of the two groups were compared.Common risk factors before dialysis,such as heart failure,digestive tract symptoms,infection,severe hyperkalemia,hemorrhage and hypertension(grade 3),vascular access,improvement of risk factors and vascular access after 3 months of dialysis were compared.Survival rate,duration of dialysis,causes of death and related factors were observed for 1,3 and 5 years in the two groups,and the effect of primary onset of end-stage renal disease on clinical prognosis of hemodialysis patients was analyzed.Results During the observation period,there were 296 patients who had long-term hemodialysis.The primary disease was diabetic nephropathy(DN)group with n = 76(25.68%)and non-diabetic nephropathy with n = 220(74.32%).1.Compared with the non-DN group,the average age of the DN group was older,58.1 +11.4 years oldVS51.1 +14.0 years old(P < 0.01).There was no difference between male and female,of which 61.8% was male(P > 0.05).The duration of onset in DN group was 13.4 + 2.8years longer than that in non-DN group(VS2.2 + 1.2 years)(P < 0.01).2.There was no difference in Hb level between the two groups before dialysis,77.07(+14.31g/lVS74.84(+16.15g/l)(P > 0.05).In DN group,albumin level was lower,urine volume was less and blood sugar was higher.The results were as follows: albumin was 32.07(+4.18g/lVS35.05(+5.18g/l)(P < 0.01),urine volume was 602.6(+197.3ml)VS756.1(+255.4ml)(P < 0.01),blood sugar was 8.09(+3).16mmol/lVS 5.50 +1.5mmol/l(P <0.01),there were significant statistical differences.The levels of eGFR and serum creatinine in DN group and non-DN group were as follows: 7.14(+3.10 ml/min/1.73m2VS4.93(+1.94 ml/min/1.73 m2)(P < 0.01),744.41(+223.55 umol/lVS1068.22(+432.97 umol/l)(P < 0.01).3.Among the risk factors before dialysis,the proportion of heart failure with pulmonary edema in DN group was significantly higher than that in non-DN group: 50% VS 19.5%(P < 0.01),31.6% VS 39.5%(P > 0.05),22.4% VS13.2%(P > 0.05),severe hyperkalemia(K > 6.5mmol/l),7.9% VS 4.5%(P > 0.05),and2.6% VS 2%(P > 0.05),bleeding.Hypertension(grade 3)31.6% VS27.3%(P > 0.05),there was no significant difference in statistics;in vascular access,the proportion of established long-term vascular access,such as the lower 9.2% VS12.7%(P > 0.05),had no statistical significance.Among them,the proportion of arteriovenous fistula in long-term access was 71.4% VS89.3%(P < 0.01),and the proportion of semi-permanent catheter was 28.6% VS.10.7%(P < 0.01),with statistical significance.The risk factors of DN group after 3 months of dialysis were as follows: heart failure with pulmonary edema was 15.8% VS 50%(P < 0.01),digestive tract symptoms was13.2% VS 31.6%(P < 0.01),infection was 9.2% VS 22.4%(P < 0.05),severe hyperkalemia was 2.6% VS 7.9%(P > 0.05),bleeding was 0% VS 2.6%(P > 0.05),hypertension(3.2%).The risk factors in DN group and non-DN group were as follows:15.8% VS 5.0%(P < 0.05),13.2% VS 4.5%(P < 0.05),9.2% VS 2.3%(P < 0.05),severe hyperkalemia 2.6% VS 1.8%(P > 0.05),bleeding 0%(P > 0.05).The proportion of hypertension(grade 3)was 14.5% VS 6.0%(P < 0.05).In terms of vascular access,the use rate of arteriovenous fistula in DN group was lower than that in non-DN group:75% VS91.4%(P < 0.01),and the use rate of semi-permanent catheter was significantly higher: 25% VS8.6%(P < 0.01).4.The 1-year,3-year and 5-year survival rates in DN group were lower than those in non-DN group.The specific results were as follows:82.9% VS95%(P < 0.01),53.9% VS74.1%(P < 0.01),39.5% VS65.0%(P < 0.01),and the duration of hemodialysis was also lower than that in non-DN group: 45.5 +33.9%VS69.0 +36.1 month.5.The causes of death in DN group and non-DN group were as follows: cardiovascular accident 28.6% VS 24.2%(P > 0.05),cerebrovascular accident44.6% VS 45.5%(P > 0.05),infection 17.9% VS 10.1%(P > 0.05).There was no significant difference between DN group and non-DN group.However,the all-cause mortality rate in DN group was 73.7% VS 45%(P < 0.01),cardiovascular accident mortality 21.1% VS 10.9%(P < 0.05),brain.Vascular accident mortality rate was32.9% VS 20.5%(P < 0.05),infection mortality rate was 13.2% VS 4.5%(P < 0.05),there was statistical difference,other mortality rate was 6.6% VS 9.1%(P > 0.05).6.Analyse the influence of age,blood sugar,weight gain/dry weight during dialysis,albumin and hemoglobin on DN group and non-DN group,survival group and death group,and find out the risk factors of death.Compared with non-DN group,DN group had older age,higher blood sugar,higher body weight gain/dry weight during dialysis,lower albumin and no difference in hemoglobin.The results were as follows:VS51.1+1+14.0 years(P < 0.01),VS51.1+14.0 years(P < 0.01),blood glucose 8.06(2.73mmol/lVS4.78(0.58mmol/l)(P < 0.01),body weight gain/dry weight during dialysis period(P < P < 0.01((P < 0.01),body weight gain/dry weight(body weight/dry weight)value 6.61((6.61((1.28VS5.83 83 +1.83 +1.83(P < 0.30(P < 0.01),albumin37.51(37.51 <4.51(4.65g/l The results of this study are as follows:1.> 0.05).The patients were divided into survival group and death group.Compared with the survivalgroup,the death group had older age,higher blood sugar,higher body weight gain/dry weight during dialysis,lower albumin and hemoglobin.The specific results were as follows: age 47.0 + 12.8 years VS58.2 + 12.4 years(P < 0.01),blood sugar 4.99 +1.03 mmol / lVS7.33 + 3.14mmol(P < 0.01),blood sugar 4.99 + 1.03 mmol / lVS7.33 +3.14mmol/ L(P < 0.01),weight gain/dry weight during dialysis was 5.27(+1.18VS6.72(+1.07)(P < 0.01),albumin was 40.97(+2.93g/lVS34.45(+5.14g/l)(P < 0.01),hemoglobin was 108.90(+18.46g/lVS97.01(+20.56/l)(P < 0.01).Conclusions Compared with non-diabetic nephropathy patients with maintenance hemodialysis,elderly patients,severe heart failure symptoms,poor nutrition,less residual urine,early dialysis period,high blood sugar,poor vascular access conditions,low survival rate and high mortality rate.Among the risk factors of death,age,hyperglycemia,sodium retention and hypoproteinemia were more obvious in end-stage diabetic nephropathy.Diabetic nephropathy dialysis time is early,early establishment of hemodialysis pathway. |
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