| Objectives: Diabetic kidney disease(DKD)has become one of the main causes of the end-stage renal disease(ESRD).Maintenance hemodialysis(MHD)is one of the main renal replacement therapy for patients with end-stage DKD.Finding the risk factors that affect the long-term survival rate of DKD hemodialysis patients and developing survival prediction models to achieve clinical intervention is particularly important to improve the long-term prognosis of DKD maintenance hemodialysis patients.This study aimed to establish a 10-year survival analysis of patients with DKD maintenance hemodialysis,based on a retrospective analysis of the medical records of inpatients with DKD maintenance hemodialysis and clinical follow-up.To evaluate the risk factors affecting the long-term survival rate among DKD patients on MHD and construct a 10-year survival nomogram to provide suggestions for evaluating the risk of death and making corresponding treatment plans.Methods: DKD patients who received maintenance hemodialysis for the first time in the Blood purification Center of the first affiliated Hospital of Kunming Medical University from January 2011 to January 2021 were selected as the study subjects.According to the death outcome,the patients were divided into a survival group and a death group,and the differences of the baseline level between the general information and laboratory examination indexes were compared between the two groups.The overall survival rate of 1-10 years in patients with DKD maintenance hemodialysis was calculated by Kaplan-Meier survival analysis and the survival curve was drawn.COX proportional hazard model was used to screen the risk factors affecting prognosis.According to the results of COX multivariate regression analysis,the 10-year survival risk nomogram was constructed by the R software,and the consistency index(C-index)and the calibration curves were used to verify the discrimination and coincidence of the nomogram for the prediction of survival probability.The above statistical methods were carried out by SPSS software and R software.Results: A total of 162 DKD patients undergoing maintenance hemodialysis were enrolled in this study.They were divided into a survival group(88 cases,54.32%)and a death group(74 cases,45.68%).In the comparison of general data,there were significant differences in sex,age of initiation of dialysis,the duration of diabetes,cardiovascular diseases,dialysis vascular access,and body mass index(BMI)between the two groups(P < 0.05).In the comparison of laboratory data,there were significant differences in red blood cell distribution width(RDW),total protein(TP),estimated glomerular filtration rate(e GFR),and high-density lipoprotein cholesterol(HDL-C)between the two groups(P<0.05).The survival analysis results showed that:(1)The Kaplan-Meier survival analysis results showed that the cumulative survival rates of DKD patients after dialysis at 1-8 and 10-year were 87.0%,72.3%,63.8%,57.2%,51.6%,40.7%,31.7%,26.4%,and 19.8%,respectively.(2)COX univariate analysis showed that age at the beginning of dialysis,sex,cardiovascular disease,the duration of diabetes,BMI,NLR,and e GFR were closely related to long-term survival(P<0.05).These seven statistically significant variables were further included in COX multivariate survival analysis.The results showed that age at the beginning of dialysis(HR=1.033,95%CI:1.008～1.059,P=0.010)and the duration of diabetes(HR=1.052,95%CI:1.014～1.092,P=0.007),NLR(HR=1.113,95%CI:1.047～1.183,P=0.007),e GFR(HR=0.835,95%CI:0.741～0.939,P=0.003),these four variables were independent risk factors affecting the prognosis of patients.(3)A nomogram risk prediction model was drawn by using these four variable factors,which can predict the 1-year,3-year,5-year,8-year,and 10-year survival rates of patients respectively.Finally,the C-index of the nomogram model is 0.769(95%CI:0.741～0.797),and the calibration curves of survival probabilities of 1 year and 5 years were drawn.The curves showed that the expected probabilities are in good agreement with the observed probabilities.Conclusions:(1)Kaplan-Meier survival analysis results showed that the cumulative survival rates of DKD patients included in this study at 1-,2-,3-,4-,5-,6-,7-,8-,10-year after dialysis was 87.0%,72.3%,63.8%,57.2%,51.6%,40.7%,31.7%,26.4% and 19.8%,respectively.(2)COX survival analysis showed that age at the beginning of dialysis,sex,cardiovascular disease,the duration of diabetes,BMI,NLR,and e GFR were closely related to the long-term survival rate of DKD maintenance hemodialysis patients,but gender,cardiovascular disease,and BMI were not independent risk factors for prognosis.(3)Based on COX multivariate regression analysis,the long-term survival risk prediction model of DKD maintenance hemodialysis patients established by age at the beginning of dialysis,the duration of diabetes,NLR,and e GFR showed consistency in the verification of the discrimination and coincidence,suggesting that the model can provide potential value for clinicians to evaluate the long term survival rate of patients. |
PDF Full Text Request