Ntu 1: Rov Qab Los Ntawm Lub Raum Ua Haujlwm Tom Qab Dialysis Pib Hauv Cov Me Nyuam Thiab Cov Neeg Laus hauv Teb Chaws Asmeskas: Txoj Kev Kawm Rov Qab Los Ntawm Tebchaws Meskas Lub Raum Cov Ntaub Ntawv Cov Ntaub Ntawv

Hu rau: emily.li@wecistanche.com

Elaine Ku, et al

1 University of California San Francisco, Division of Nephrology, Department of Medicine, San Francisco, California, United States of America, 2 University of California San Francisco, Division of Pediatric Nephrology, Department of Pediatrics, San Francisco, California, Tebchaws Asmeskas , 3 University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, California, United States of America, 4 Hennepin Healthcare thiab University of Minnesota, Department of Medicine, Division of Nephrology, Minneapolis, Minnesota, United States of America, 5 Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Division of Pediatric Nephrology and Hypertension, Cincinnati, Ohio, United States of America, 6 University of California San Francisco, Department of Anesthesia thiab Perioperative Care, San Francisco, California, United States of America

Ntsiab lus:Cistanche, Cov txiaj ntsig Cistanche,raum ua haujlwm, kab mob raum

Abstract

Keeb kwm

Tsawg tsis paub txog yam cuam tshuam nrog kev rov qab los ntawmraum muaj nuj nqi-thiab rov qab mus rau kev lim ntshav ywj pheej-lossis ib ntus kev hloov pauv hauv lub sijhawm rov qab los tom qab pib kev lim ntshav tawm hauv Tebchaws Meskas. Nkag siab txog cov yam ntxwv ntawm cov tib neeg uas yuav muaj peev xwm rov zooraummuaj nuj nqituaj yeem txhawb kev paub zoo ntawm cov xwm txheej zoo li no. Lub hom phiaj ntawm txoj kev tshawb no yog los txiav txim siab txog yam cuam tshuam nrog kev rov qab los ntawmraummuaj nuj nqiHauv cov menyuam yaus piv nrog cov neeg laus pib lim ntshav hauv Asmeskas.

Cov txheej txheem thiab kev tshawb pom

Peb txiav txim siab yam cuam tshuam nrog kev rov qab los ntawmraummuaj nuj nqi-txhais tias muaj sia nyob thiab kev txiav tsis tu ncua ntawm kev lim ntshav rau 90-hnub lub sijhawm - hauv cov menyuam yaus piv rau cov neeg laus uas tau pib kho kev lim ntshav nruab nrab ntawm 1996 thiab 2015 raws li United States Renal Data System (USRDS) ua raws li xyoo 2016 hauv kev tshawb fawb rov qab. Peb kuj tau tshuaj xyuas qhov sib txawv ntawm lub cev hauv cov nqi rov qab los ntawm 2 xyoo dhau los hauv pawg neeg no. Ntawm 1,968,253 tus neeg suav nrog hauv txoj kev tshawb no, lub hnub nyoog nruab nrab yog 62.6 ± 15.8 xyoo, thiab 44 feem pua ​​​​yog poj niam. Zuag qhia tag nrho, 4 feem pua ​​​​ntawm cov neeg laus (83,302/1,953,881) thiab 4 feem pua ​​​​ntawm cov menyuam yaus (547/14,372) pib lim ntshav hauv qhov chaw kho mob sab nraud tau zooraummuaj nuj nqihauv 1 xyoo. Ntawm cov neeg uas rov zoo, lub sijhawm nruab nrab ntawm kev rov zoo yog 73 hnub (interquartile range [IQR] 43–131) hauv cov neeg laus thiab 100 hnub (IQR 56–189) hauv cov menyuam yaus. Kev suav nyiaj rau kev sib tw ntawm kev pheej hmoo tuag, cov menyuam yaus tsis tshua muaj peev xwm rov zooraummuaj nuj nqipiv nrog cov neeg laus (sub-hazard ratio [sub-HR] 0.81; 95 feem pua ​​CI 0.74–{7}}.89, p-value<0.001; point="" estimates=""><1 indicating="" increased="" risk="" for="" a="" negative="" outcome).="" non-hispanic="" black="" (nhb)="" adults="" were="" less="" likely="" to="" recover="" compared="" with="" non-hispanic="" white="" (nhw)="" adults,="" but="" these="" racial="" differences="" were="" not="" observed="" in="" children.="" of="" note,="" a="" steady="" increase="" in="" the="" incidence="" of="" recovery="" of="">raummuaj nuj nqitau sau tseg thawj zaug hauv cov neeg laus thiab menyuam yaus thaum xyoo 1996 thiab 2010, tab sis qhov kev hloov no tau poob qis tom qab ntawd. Cov kev kuaj mob uas cuam tshuam nrog kev rov zoo siab tshaj plaws ntawm kev rov zoo yog mob tubular necrosis (ATN) thiab mob nephritis (AIN) hauv cov neeg laus thiab menyuam yaus, qhov twg 25 feem pua ​​- 40 feem pua ​​​​ntawm cov neeg mob tau zoo.raummuaj nuj nqinyob ntawm lub xyoo daim ntawv qhia hnub ntawm kev lim ntshav pib. Cov kev txwv rau peb txoj kev tshawb fawb suav nrog qhov muaj peev xwm rau qhov seem ntawm qhov tsis txaus ntseeg kom muaj nyob rau hauv qhov kev soj ntsuam ntawm peb cov ntaub ntawv.

Cov lus xaus

Hauv txoj kev tshawb no, peb tau pom tias kev txiav tawm ntawm cov neeg mob ntshav qab zib tsis tu ncua vim qhov rov zoo tau tshwm sim hauv 4 feem pua ​​​​ntawm cov neeg mob uas muaj qhov kawg.raumkab mob(ESKD) thiab muaj ntau dua ntawm cov neeg uas muaj ATN lossis AIN ua rau lawvraumkab mob. Thaum cov nqi rov qab tau nce pib, lawv tsis kam pib xyoo 2010. Cov kev tshawb fawb ntxiv yog xav tau kom nkag siab tias yuav ua li cas thiaj paub zoo tshaj plaws thiab txhawb kev rov zoo rau cov neeg mob uas nws muaj peev xwm txiav kev lim ntshav siab hauv qhov chaw kho mob sab nraud.

Cistanche tuaj yeem txhim kho lub raum ua haujlwm

Sau cov ntsiab lus

Vim li cas qhov kev tshawb fawb no ua tiav?

• Cov yam ntxwv uas kwv yees muaj peev xwm zoo rau kev rov qab los ntawmraummuaj nuj nqihauv cov neeg mob dialysis yog ib qho tseem ceeb los txheeb xyuas kom cov tib neeg uas muaj peev xwm rov zoo tuaj yeem ua raws li lawv txoj kev rov qab los thiab lees paub.

• Lub hom phiaj ntawm txoj kev tshawb no yog los txiav txim seb qhov yuav rov qab los ntawmraummuaj nuj nqitom qab pib kev kho mob lim dej hauv cov menyuam yaus thiab cov neeg laus.

Cov kws tshawb fawb tau ua dab tsi thiab pom?

•Peb pom tias 4 feem pua ​​ntawm cov menyuam yaus thiab cov neeg laus zoo li qubraummuaj nuj nqitom qab pib lim ntshav, tab sis cov me nyuam tsis muaj feem yuav rov qab ua haujlwm rau lub raum piv nrog cov neeg laus.

• Cov nqi rov qab tau zoo dua thaum pib ntawm cov menyuam yaus thiab cov neeg laus tab sis pib poob qis nyob rau xyoo 2010 thiab txawv nyob ntawm hnub nyoog, haiv neeg, thiab ua rauraumkab mob.

Cov kev tshawb pom no txhais li cas?

•Kev txiav tawm ntawm tus neeg mob sab nraud dialysis vim qhov rov zoo ntawmraummuaj nuj nqitau pom nyob rau hauv kwv yees li 4 feem pua ​​​​ntawm cov neeg mob uas muaj qhov kawgraumkab mob(ESKD) tab sis tshwj xeeb tshaj yog nyob rau hauv cov neeg uas muaj mob tubular necrosis (ATN) lossis mob nephritis (AIN) ua rau lawv.raumkab mob.

• Yuav tsum muaj kev tshawb fawb ntxiv kom nkag siab txog yuav ua li cas thiaj paub zoo tshaj thiab txhawb kev rov qab los ntawm cov neeg mob uas nws muaj peev xwm txiav kev lim ntshav siab hauv qhov chaw kho mob sab nraud.

Cistanchetxhim kholub raum ua haujlwmthiab pab rov qab ntawmlub raum ua haujlwm

Taw qhia

Cov neeg mob uas mob raum raug mob (AKI) nyob rau hauv qhov teeb meem ntawm kev mob los yog mus pw hauv tsev kho mob feem ntau yuav tsum tau pib lim ntshav sai [1–3]. Ib feem ntau ntawm cov neeg mob no yuav muaj sia nyob lawv qhov chaw pw hauv tsev kho mob thawj zaug thiab raug tso tawm mus rau qhov chaw kho mob sab nraud nrog cov kev cai rau kev lim ntshav txuas ntxiv [4–7]. Txawm li cas los xij, subsets ntawm cov neeg mob sab nraud no tuaj yeem muaj peev xwm rov qab los rau lub raum txaus kom thiaj li txiav tsis tu ncua tu lub lim ntshav. Cov kev tshawb fawb ua ntej tau tshaj tawm tias kwv yees li 40 feem pua ​​​​ntawm cov neeg mob uas pib lim ntshav tom qab AKI thiab txuas ntxiv cov neeg mob lim ntshav tom qab tawm hauv tsev kho mob tau rov zoo txaus hauv 1 xyoo [8]. Txawm nyob rau hauv cov neeg mob uas muaj mob ntevraumkab mob(CKD) uas tsis tshwm sim raug kev tsim txom hnyav ua ntej kev lim ntshav, qhov kev txiav txim siab pib lim ntshav yuav ua raws li cov yam ntxwv uas tsis tas mus li (xws li kev ua tsis zoo rau kev txwv kev noj zaub mov lossis kev thauj mus los tsis txaus ntseeg rau cov chaw muab kev saib xyuas zoo), yog li tias txawm tias cov neeg mob tsis xav tias muaj qhov tsis zoo ntawm lub raum kev ua haujlwm tuaj yeem rov zoo txaus rau lub raum ua haujlwm kom tswj tau qhov homeostasis thiab txiav kev lim ntshav txawm hais tias tus kab mob tau pom zoo raws li theem kawg.raumkab mob(ESD) [9].

Muab qhov kev txhawb siab loj zuj zus los txo qhov ntev ntawm kev mus pw hauv tsev kho mob [10] thiab kev them nyiaj txoj cai hloov pauv hauv kaum xyoo dhau los nyob ib puag ncig AKI thiab ESKD kev saib xyuas [11,12], kev hloov pauv ntawm lub raum rov qab rau hauv cov neeg mob ntshav qab zib sab nraud tau tshwm sim [11,13 ]. Tsis tas li ntawd, qhov kev xav mus rau qhov pib ntawm kev lim ntshav ntawm qhov nce siab dua qhov kwv yees glomerular pom tus nqi (eGFR; thiab muaj peev xwm ua ntej kev lim ntshav yog qhia kiag li) nyob rau 2 xyoo dhau los hauv Tebchaws Meskas [14–17] tej zaum yuav ua rau muaj qhov tshwm sim uas muaj feem cuam tshuam. ntawm cov neeg mob uas pib lim ntshav tom qab "rov qab" los ntawm kev lim ntshav; Qhov tshwm sim no kuj tseem tuaj yeem cuam tshuam rau cov neeg mob uas tau lim ntshav-yuav tsum tau AKI. Cov qauv mus rau kev pib lim ntshav ua ntej tau raug pom txawm tias tau tshaj tawm qhov kev sim loj hauv xyoo 2010 uas pom tias tsis muaj txiaj ntsig zoo los ntawm kev pib ua ntej ntawm kev lim ntshav [14]. Txawm li cas los xij, ib sab ntawm cov kev tshawb fawb ib leeg tau tsom mus rau cov neeg laus cov neeg laus [3,18,19], qhov tshwm sim thiab kev kwv yees ntawm kev rov qab los.raummuaj nuj nqitom qab kev pib kho mob rau tus neeg mob sab nraud rau cov neeg laus thiab cov menyuam yaus tsis tau piav qhia zoo nyob rau hauv lub tebchaws.

Lub hom phiaj ntawm txoj kev tshawb no yog los txiav txim cov yam ntxwv ntawm cov neeg laus (18 xyoo lossis tshaj saud) lossis cov menyuam yaus (<18 years)="" who="" recovered="" sufficient="">raummuaj nuj nqikom tsis txhob lim ntshav rau yam tsawg kawg 90 hnub tom qab pib kho cov neeg mob sab nraud kho mob lim ntshav raws li UnitedStates Renal Data System (USRDS), lub teb chaws ESKD npe uas ntes txhua tus neeg mob uas tau kho ntshav lim ntshav hauv Asmeskas. Peb kuj tau tshuaj xyuas cov xwm txheej ntawm lub cev nyob rau hauv kev txiav tsis tu ncua ntawm kev saib xyuas kev lim ntshav nyob rau lub sijhawm thiab muab piv cov qauv no rau cov neeg laus thiab menyuam yaus. Peb tau xaiv suav nrog cov neeg laus thiab cov menyuam yaus txhawm rau txhim kho peb txoj kev nkag siab txog qhov sib txawv ntawm cov kab mob etiology, cov qauv kev coj ua, thiab kev sib tw kev pheej hmoo ntawm kev tuag (uas tsis tshua muaj nyob rau hauv cov menyuam yaus uas muaj ESKD) yuav cuam tshuam nrog qhov muaj feem cuam tshuam nrog kev tu ncua kev lim ntshav hauv 1 xyoos. kev pib kho mob hauv cov chaw kho mob sab nraud.

Cov txheej txheem

Tshawb nrhiav cov pejxeem thiab cov ntaub ntawv

Peb tau ua qhov kev tshawb fawb rov qab ntawm txhua tus neeg uas pib mob ntshav qab zib sab nraud thaum lub Ib Hlis 1, 1996, thiab Kaum Ob Hlis 31, 2015, siv cov ntaub ntawv los ntawm USRDS, lub teb chaws ESKD npe. Cov yam ntxwv ntawm pej xeem, tus cwj pwm ua rau ESKD, kev tuav pov hwm, zip code, hnub tim ntawm ESKD pib, thiab haiv neeg thiab haiv neeg (categorized as non-Hispanic white [NHW], Hispanic, non-Hispanic black [NHB], Neeg Esxias, lossis lwm yam ) ntawm qhov xwm txheej ESKD tau pom los ntawm Lub Tsev Haujlwm rau Medicare & Medicaid Services 2728 (CMS-2728) ​​Daim Ntawv Pov Thawj Kho Mob (MEDEVID) thiab PATIENTS cov ntaub ntawv hauv USRDS. Zip code tau siv los txiav txim qhov nruab nrab ntawm tsev neeg cov nyiaj tau los ntawm cov neeg mob cov neeg nyob ib puag ncig siv cov txiaj ntsig los ntawm American Community Survey ntawm 2006 thiab 2010 [20]. Thawj ESKD kev kho mob modality (peritoneal dialysis piv rau hemodialysis) tau txiav txim siab nyob rau thawj hnub pab ESKD raws li RXHIST (kho keeb kwm) cov ntaub ntawv. Peb tau tshuaj xyuas qhov kev sib raug zoo ntawm lub sijhawm nruab nrab ntawm lub xyoo daim ntawv qhia hnub ntawm kev pib lim ntshav thiab rov qab los ntawmraummuaj nuj nqisiv cov cubic splines.

Lub ntsiab lus ntawm kev rov qab los thiab tsis txuas ntxiv ntawm kev saib xyuas kev lim ntshav

Cov neeg mob tau sau npe hauv USRDS tom qab tus kws kho mob tau lees paub lawv qhov xwm txheej ESKD los ntawm kev xa cov ntaub ntawv CMS -2728 MEDEVID uas yuav tsum tau ua hauv 45 hnub ntawm kev pib lim ntshav. Cov ntaub ntawv RXHIST sib sau ua ke cov ntaub ntawv los ntawm Medicare Claims, CROWNWeb (cov ntaub ntawv kev tswj hwm los ntawm Medicare-certified dialysis cov chaw qhia txog kev ntsuas rau CMS), CMS -2728 daim ntawv, CMS Daim Ntawv Ceeb Toom Txog Kev Tuag, thiab Cov Khoom Siv Hauv Paus Hloov Hloov Network Hloov cov ntaub ntawv los hloov kho cov xwm txheej raws li lub sijhawm [21]. Peb tau siv cov ntaub ntawv RXHIST los txheeb xyuas qhov kev kho ESKD thawj zaug, hnub ntawm kev pib lim ntshav ntev, thiab kev hloov pauv hauv kev kho mob suav nrog kev tshem tawm ntawm kev lim ntshav. Txhua tus neeg mob uas muaj CMS-2728 daim ntawv ua tiav tau tsim nyog rau kev suav nrog hauv txoj kev tshawb fawb.

Cov neeg mob tau pom tias tau zoo lawmraummuaj nuj nqiyog tias lawv ntsib tag nrho cov hauv qab no:

(1) lawv tau sau tseg tias tau zoo lawmraummuaj nuj nqiraws li cov ntaub ntawv RXHIST thiab tsis muaj qhov rov pib lim ntshav hauv 90 hnub ntawm hnub rov qab los; (2) tus neeg mob tsis tuag nyob rau hauv 90 hnub ntawm kev tso tseg kev kho mob dialysis (thiab tej zaum yuav rho tawm los ntawm kev kho mob dialysis); thiab (3) tus neeg mob tsis tau txais ib lub raum hloov hauv 90 hnub tom qab tso tseg kev lim ntshav. Ib lub sijhawm 90-hnub tsis pub lim ntshav yuav tsum tau ua kom rov qab ua tau raws li cov lus txhais raws li USRDS (uas tseem yuav tsum muaj sijhawm 90-hnub ntawm kev lim ntshav ywj pheej) [21]. Cov neeg mob uas tau txais kev hloov pauv txhua lub sijhawm tau censored txij li txawm tias rov qab losraummuaj nuj nqitshwm sim tom qab hloov lub raum, nws yuav nyuaj rau paub qhov txawv haiv neegraummuaj nuj nqilos ntawm allograft muaj nuj nqi.

Kev soj ntsuam tau pib ntawm thawj ntu ntawm kev pib lim ntshav raws li RXHIST cov ntaub ntawv (thiab tsis tas yuav tsum muaj lub sijhawm ua ntej ntawm kev lim ntshav rau kev suav nrog hauv peb txoj kev tshawb fawb) thiab xaus rau hnub ntawm lub raum rov qab, tuag, 365 hnub tom qab kev lim ntshav, lossis kev tswj xyuas censoring hnub (Lub Kaum Ob Hlis 31, 2016). Peb tau xaiv los tsom mus rau lub raum rov qab uas tau tshwm sim hauv 1 xyoos ntawm kev pib kho mob ntshav qab zib sab nraud raws li tus nqi rov qab los ntawmraummuaj nuj nqitom qab ntawd tau qis. Txawm li cas los xij, hauv kev tshuaj ntsuam rhiab heev, peb kuj tau tshuaj xyuas cov kev kwv yees ntawm qhov tshwm sim ntawm kev rov qab los ntawm txhua lub sijhawm thaum kev tshawb nrhiav.

Kev kwv yees ntawm kev rov ua haujlwm ntawm lub raum

Peb thawj zaug tshuaj xyuas cov yam ntxwv ntawm cov neeg mob uas zoo li qubraummuaj nuj nqihauv cov menyuam yaus piv nrog cov neeg laus. Cov yam ntxwv ntawm kev txaus siab suav nrog hnub nyoog (raws li 6- pawg sib txawv), poj niam txiv neej, haiv neeg, hom kev tuav pov hwm, thawj qhov ua rau ESKD, cov nyiaj tau los nruab nrab ntawm cov neeg nyob ib puag ncig, kev kho tus neeg mob thawj zaug (hemodialysis lossis peritoneal dialysis), lub sijhawm daim ntawv qhia hnub (sib faib ua 5-xyoo ib ntus), thaj tsam ntawm Teb Chaws Asmeskas (West, Northeast, South, thiab Midwest), thiab cov nyiaj tau los nruab nrab ntawm cov zej zog.

Tom ntej no, peb siv Fine thiab Grey qauv los tshuaj xyuas cov kwv yees ntawm kev rov qab los ntawmraummuaj nuj nqisuav nrog cov neeg sib tw sib txawv uas tau teev tseg saum toj no hauv ob qho tib si univariable thiab multivariable analyses. Cov qauv sib txawv muaj xws li covariates uas tau teev tseg saum toj no thiab cov kab mob sib kis nrog rau cov kab mob plawv, mob plawv, plawv tsis ua hauj lwm, kub siab, ntshav qab zib, kab mob peripheral vascular, mob stroke, haus luam yeeb, thiab siv yeeb tshuaj raws li qhia hauv daim ntawv CMS -2728. Hauv cov qauv no, lub sijhawm tau pib los ntawm thawj zaug kev kho mob rau tus neeg mob sab nraud (thiab peb tsis xav kom cov neeg mob muaj tsawg kawg 90 hnub ntawm kev lim ntshav kom suav nrog rau kev kawm), kev tuag raug kho raws li kev sib tw, thiab kev soj ntsuam tau raug censored. ntawm kev hloov pauv lossis kev tswj hwm ntawm 1 xyoos tom qab kev kho mob ntshav qab zib thawj zaug. Piv txwv li, kev phom sij<1 in="" these="" models="" indicate="" a="" negative="" outcome="" (lower="" likelihood="" of="" recovery="" of="">raummuaj nuj nqi) nyob rau hauv txoj kev tshawb no. Rau cov qauv no, peb suav nrog cov neeg laus thiab menyuam yaus hauv tib tus qauv kom muaj kev sib piv tuaj yeem ua rau tag nrho cov hnub nyoog spectrum. Peb kuj piv cov me nyuam (<18 years)="" and="" adults="" (18="" years="" or="" older)="" as="" a="" 2-category="" predictor="" to="" determine="" the="" overall="" risk="" of="" recovery="" in="" univariable="" and="" multivariable="" analysis,="" adjusted="" for="" the="" same="" covariates="" as="" described="">

Tom ntej no, peb tau sim rau qhov sib txawv ntawm kev sib koom ua ke ntawm ntau tus yam ntxwv thiab kev phom sij ntawm kev rov qab los ntawm cov menyuam yaus thiab cov neeg laus los ntawm kev sim rau kev sib cuam tshuam ntawm kev sib deev, haiv neeg, ua rauraumkab mob, kev kho mob thawj zaug, hom kev tuav pov hwm, cov nyiaj tau los nruab nrab, daim ntawv qhia hnub xyoo ntawm kev pib lim ntshav, thiab cheeb tsam hauv Teb Chaws Asmeskas nrog hnub nyoog thaum lub sij hawm pib lim ntshav (<18 years="" versus="" �18="" years)="" in="" unadjusted="" models.="" for="" factors="" where="" we="" found="" statistically="" significant="" interactions="" (p="" <="" 0.05),="" we="" then="" repeated="" our="" fine="" and="" gray="" analyses="" stratified="" by="" whether="" the="" patient="" was="" a="" child="" or="" adult="" at="" the="" time="" of="" dialysis="" initiation="" to="" understand="" how="" these="" factors="" differed="" among="" these="" populations="" in="" their="" association="" with="" recovery.="" we="" did="" not="" test="" for="" interactions="" between="" comorbidities="" given="" the="" low="" prevalence="" of="" comorbid="" conditions="" in="" the="" pediatric="">

Cistanche cov txiaj ntsigrov qab ntawmlub raum ua haujlwmthiab txhim kho cov qog adrenal ua haujlwm

Cov pab pawg neeg soj ntsuam ntawm cov kev kuaj mob nrog cov nqi siab ntawm kev rov ua haujlwm ntawm lub raum

Peb tau txheeb xyuas cov txiaj ntsig ntawm ESKD nrog cov nqi siab tshaj plaws ntawm kev rov qab los ntawmraummuaj nuj nqirau menyuam yaus thiab cov laus. Rau txhua qhov kev kuaj mob no, peb tau txiav txim siab lub sijhawm nruab nrab ntawm kev rov qab los ntawm cov menyuam yaus thiab cov neeg laus sib cais ntawm cov neeg uas rov zoo.raummuaj nuj nqithiab tseem muaj qhov feem pua ​​​​ntawm cov neeg uas rov qab los ntawm 30, 90, thiab 180 hnub ntawm kev soj ntsuam.

Temporal tiam sis nyob rau hauv lub rov qab ntawm lub raum ua hauj lwm

Txhawm rau tshuaj xyuas qhov sib txawv ntawm lub cev hauv kev rov qab los ntawmraummuaj nuj nqi, peb tau ua qauv lub sij hawm raws li lub cubic spline nrog pob qhov rooj hauv xyoo 2000, 2004, 2008, thiab 2012 hauv cov qauv kab rov tav uas qhov tshwm sim yog qhov nruab nrab ntawm cov neeg mob uas zoo li qub hauv 1 xyoo ntawm kev pib lim ntshav. Peb tau ua cov kev soj ntsuam no nyias nyias rau cov menyuam yaus thiab cov neeg laus thiab cov neeg mob ESKD uas yog los ntawm tus mob tubular necrosis (ATN) lossis mob nephritis (AIN) uas yog 2 qhov kev kuaj mob uas muaj kev rov zoo siab tshaj plaws hauv cov menyuam yaus thiab cov neeg laus.

Tom ntej no, peb rov hais dua peb cov qauv regression nrog lub sij hawm raws li lub cubic spline thiab rov qab los raws li qhov tshwm sim, tab sis stratified peb cov qauv los ntawm seb tus neeg mob pib dialysis ntxov (10 mL / min / 1.73 m2) piv rau lig (<10 ml/min/1.73="" m2)="" in="" adults="" and="" children="" separately.="" we="" determined="" the="" egfr="" at="" dialysis="" initiation="" using="" the="" creatinine-based="" ckd-epi="" equation="" in="" adults="" [22]="" and="" schwartz="" equation="" [23]="" in="" children.="" serum="" creatinine="" is="" routinely="" reported="" on="" the="" cms-2728="" form,="" which="" asks="" providers="" to="" certify="" the="" latest="" creatinine="" value="" within="" 45="" days="" prior="" to="" the="" most="" recent="" episode="" of="" dialysis="" initiation.="" for="" egfr="" determination,="" any="" serum="" creatinine="" reported="" more="" than="" 7="" days="" after="" dialysis="" initiation="" was="" set="" as="">

Lub Tsev Kawm Ntawv Qib Siab California San Francisco Institutional Review Board txiav txim siab qhov kev tshawb fawb no tsis yog tib neeg kev tshawb fawb thiab zam qhov yuav tsum tau muaj kev pom zoo rau kev ncaj ncees. Kev tshuaj xyuas tau ua nyob rau hauv STATA 16 (Stata, Texas, US) thiab txheeb xyuas los ntawm tus kws tshuaj ntsuam cais siv SAS 9.4 (SAS Institute, North Carolina, US) siv USRDS cov ntaub ntawv uas cov kws sau ntawv tau nkag mus rau tag nrho thiab muaj rau pej xeem ntawm https: //www.usrds.org/for-researchers/simple-data-requests/. Vim muaj kev ncua sij hawm khiav rau qee qhov kev ntsuam xyuas, peb siv txoj hauv kev ua kom muaj txiaj ntsig zoo dua los ua qhov kev sib tw kev pheej hmoo. Qhov no suav nrog kev ua cov ntaub ntawv ua ntej, suav cov qhov hnyav ntawm lub sijhawm, thiab siv cov qauv Cox proportional kev phom sij uas suav nrog qhov hnyav [24,25].

Peb txoj kev npaj tshuaj ntsuam xyuas tau teev tseg qhov tseem ceeb hauv lub rooj sib tham ntawm coauthors nrog lub hom phiaj ntawm kev tshuaj xyuas qhov sib txawv hauv kev rov qab los ntawmraummuaj nuj nqinyob rau hauv 1 xyoo ntawm pib dialysis rau cov neeg laus thiab cov me nyuam. Spline-raws li kev txheeb xyuas los tshuaj xyuas cov xwm txheej ntawm lub cev hauv kev rov qab los ntawmraummuaj nuj nqitau ntxiv tom qab ua tiav cov kev ntsuam xyuas tseem ceeb tau txais kev lees paub tias cov koom haum no tuaj yeem hloov pauv raws sijhawm. Keeb kwm, txoj kev npaj tshuaj ntsuam xyuas tsuas yog tshuaj xyuas kev rov qab los ntawmraummuaj nuj nqinyob rau hauv 1 xyoo ntawm kev pib lim ntshav, tab sis raws li qhov kev thov ntawm cov neeg saib xyuas thaum lub sij hawm kho, peb tau txuas ntxiv kev soj ntsuam kom rov qab mus rau qhov kawg ntawm lub sij hawm kawm thiab ntxiv qhov no raws li kev soj ntsuam ntxiv. Txoj kev tshawb no tau tshaj tawm raws li Kev Txhim Kho Kev Tshaj Tawm Txog Kev Tshawb Fawb Kev Tshawb Fawb hauv Kev Kab Mob Kab Mob (STROBE) cov lus qhia (S1 Daim Ntawv Teev Npe).

Cistanche tiv thaiv lub plawv thiab txhim kho lub raum ua haujlwm

Cov txiaj ntsig

Kev kwv yees ntawm kev rov ua haujlwm ntawm lub raum hauv cov neeg laus thiab menyuam yaus

Peb tau txheeb xyuas 1,953,881 tus neeg laus uas pib mob ntshav qab zib sab nraud ntawm 1996 thiab 2015. Zuag qhia tag nrho, lub hnub nyoog nruab nrab ntawm cov neeg laus yog 63 ± 15.2 xyoo, 44 ​​feem pua ​​​​yog poj niam, 28 feem pua ​​​​yog NHB thiab 13 feem pua ​​yog neeg Mev. Ntawm cov neeg mob no, 83,302 (4.3 feem pua) rov zoo txausraummuaj nuj nqithiab muaj peev xwm tau txais kev ywj pheej los ntawm kev lim ntshav hauv ib lub sijhawm {{0}} xyoo, thiab ntxiv 12,360 (0.6 feem pua) cov tib neeg tau rov qab txausraummuaj nuj nqikom tsis txhob dialysis thaum lub sij hawm ntev kev soj ntsuam

dhau qhov kawg ntawm kev kawm. Ntawm cov recovering, qhov nruab nrab lub sij hawm rov qab los ntawmraummuaj nuj nqinyob rau hauv cov neeg laus pawg yog 73 hnub (interquartile range [IQR] 43 txog 132). Kwv yees li 22 feem pua ​​​​tau tuag (N=439,552) ua ntej rov qab losraummuaj nuj nqinyob rau hauv ib lub sijhawm 1- xyoo.

Peb tau txheeb xyuas 14,372 tus menyuam yaus uas pib lim ntshav thaum xyoo 1996 thiab 2015. Zuag qhia tag nrho, lub hnub nyoog nruab nrab ntawm cov menyuam yaus yog 10.3 ± 5.9 xyoo, 45 feem pua ​​​​yog cov ntxhais, 25 feem pua ​​​​yog NHB thiab 27 feem pua ​​​​yog neeg Mev. Ntawm cov neeg mob no, 547 (3.8 feem pua) tau zoo txausraummuaj nuj nqithiab tau txais kev ywj pheej los ntawm kev lim ntshav hauv ib lub sijhawm 1-xyoo. Kwv yees li 4 feem pua ​​​​ntawm cov menyuam yaus tuag (N=586) ua ntej rov qab losraummuaj nuj nqinyob rau hauv ib lub sijhawm 1- xyoo. Lub sijhawm nruab nrab ntawm kev rov qab losraummuaj nuj nqihauv pawg menyuam yaus yog 100 [IQR 56 txog 189] hnub yog tias rov qab tshwm sim.

Hauv 3 lub hlis ntawm kev lim ntshav, 5.8 feem pua ​​​​ntawm cov menyuam yaus (N=831) thiab 0.5 feem pua ​​​​ntawm cov neeg laus (N=8,790) tau txais kev hloov raum. Hauv 1 xyoos ntawm kev lim ntshav, 30.3 feem pua ​​​​ntawm cov menyuam yaus (N=4,350) thiab 2.4 feem pua ​​​​ntawm cov neeg laus (N=47,201) tau txais kev hloov raum. Kwv yees li ntawm 71 feem pua ​​(N=1,384,412) ntawm cov neeg laus thiab 62 feem pua ​​​​ntawm cov menyuam yaus (N=8,889) raug censored tswj raws li lawv tsis mus txog qhov kawg ntawm kev txaus siab los ntawm 1 xyoo ntawm kev soj ntsuam. Qhov feem pua ​​​​ntawm cov menyuam yaus thiab cov neeg laus uas tau rov qab los ntawm ntau lub sijhawm muaj nyob hauv S1 Fig.

Cov yam ntxwv ntawm cov neeg laus thiab cov menyuam yaus uas zoo li qubraummuaj nuj nqimuaj nyob rau hauv Table 1. Kev ua tau zoo, feem ntau ntawm cov neeg laus uas rov zoo li qub, feem ntau yuav yog NHW, txiv neej, thiab feem ntau yuav tau pib kho mob sab nraud nrog hemodialysis (piv rau peritoneal dialysis) dua li cov neeg uas tsis zoo.raummuaj nuj nqi. Qhov zoo, feem ntau ntawm cov menyuam yaus uas rov qab los kuj tseem hluas dua, tab sis feem ntau yuav yog NHB lossis lwm haiv neeg, thiab poj niam (Table 1). Txawm hais tias pib hemodialysis raws li qhov kev kho mob thawj zaug kuj tseem cuam tshuam nrog kev rov zoo ntau dua li pib nrog kev lim ntshav peritoneal hauv cov menyuam yaus, feem ntau ntawm cov menyuam yaus pib mob ntshav qab zib peritoneal dialysis (3.5 feem pua, N=243) zoo tu qab.raummuaj nuj nqipiv nrog cov neeg laus (1.4 feem pua ​​, N=2,115, Table 1).

Cov pab pawg neeg soj ntsuam ntawm cov kev kuaj mob nrog cov nqi siab ntawm kev rov ua haujlwm ntawm lub raum

Qhov ua rau ntawmraumkab mobnrog qhov tshwm sim siab tshaj plaws ntawm kev rov qab los ntawm cov neeg laus yog AIN (33 feem pua, N=1,381) thiab ATN (29 feem pua, N=14,380, Table 1). Hauv cov neeg laus nrog cov kev kuaj mob no, lub sijhawm nruab nrab ntawm kev rov qab los ntawm cov neeg uas rov zoo yog 49 [IQR 31 txog 83] thiab 58 [IQR 36 txog 98] hnub, raws li.

Qhov ua rau ntawmraumkab mobntawm cov menyuam yaus uas muaj qhov tshwm sim zoo tshaj plaws yog ATN (18 feem pua ​​, N=54), AIN (N<11) followed="" by="" glomerulonephritis="" (5%, n="278," table="" 1).="" the="" median="" time="" to="" recovery="" among="" those="" who="" recovered="" with="" these="" diagnoses="" were="" 136="" days="" [iqr="" 48="" to="" 229],="" 32="" days="" [iqr="" 17="" to="" 46],="" and="" 93="" days="" [iqr="" 51="" to="" 176],="">

Kev kwv yees ntawm kev rov qab los ntawm cov neeg laus piv rau menyuam yaus

Zuag qhia tag nrho, tom qab suav txog qhov sib tw txaus ntshai ntawm kev tuag, cov menyuam yaus tsis tshua muaj peev xwm rov zoo dua piv nrog cov neeg laus (tsis muaj kev tshuaj ntsuam xyuas: sub-hazard ratio [sub-HR] 0.95; 95 feem pua ​​​​CI 0. 87 mus rau 1.03; p=0.24; kho cov tshuaj ntsuam xyuas: sub-HR 0.81 [95 feem pua ​​CI 0.74 txog 0.89]; p<0.001). considering="" the="" full="" age="" spectrum,="" recovery="" was="" more="" likely="" to="" occur="" in="" the="" 0-=""><5-year-old age="" groups="" (sub-hr="" 1.04;="" 95%="" ci="" 0.88="" to="" 1.23, p="0.64)," although="" this="" did="" not="" reach="" statistical="" significance,="" and="" less="" likely="" in="" the="" 5-=""><13-year-old (sub-hr="" 0.63;="" 95%="" ci="" 0.52="" to=""><0.001) and="" 13-=""><18-year-old age="" groups="" (sub-hr="" 0.64;="" 95%="" ci="" 0.56="" to=""><0.001) in="" adjusted="" analyses="" (table="" 2).="" female="" sex="" (sub-hr="" 0.98;="" 95%="" ci="" 0.96="" to=""><0.001), nhb="" (sub-hr="" 0.52;="" 95%="" ci="" 0.51="" to=""><0.001), and="" hispanic="" groups="" (sub-hr="" 0.66;95%="" ci="" 0.64="" to=""><0.001), those="" starting="" treatment="" with="" peritoneal="" dialysis="" (sub-hr="" 0.34;="" 95%="" ci="" 0.32="" to=""><0.001), those="" with="" urologic/cystic/congenital="" causes="" of="">raumkab mob(sub-HR 0.08; 95% CI 0.08 txog 0.09, p<0.001) or="" diabetes="" (sub-hr="" 0.09;="" 95%="" ci="" 0.09="" to=""><0.001), and="" residence="" in="" the="" northeastern="" part="" of="" the="" us="" (sub-hr="" 0.72;="" 95%="" ci="" 0.70="" to=""><0.001) were="" predictors="" associated="" with="" lower="" recovery="" rates="" in="" the="" overall="" population="" in="" multivariable="" models="" (table="" 2).="" similar="" findings="" were="" noted="" in="" sensitivity="" analyses="" when="" we="" extended="" follow-up="" to="" end="" of="" the="" study="" (s1="">

Txawm li cas los xij, qee qhov kev kwv yees ntawm kev rov qab los sib txawv ntawm cov neeg laus thiab cov menyuam yaus (kev pom muaj kev cuam tshuam tau pom) raws li qhia hauv Table 3. Txawm li cas los xij, cov poj niam muaj kev phom sij tsawg dua li cov txiv neej (sub-HR 0.97; 95 feem pua ​​​​CI { {5}}.96 rau 0.99, p < 0.001), cov ntxhais muaj kev phom sij ntau dua li cov tub (sub-HR 1.47; 95 feem pua ​​​​CI 1.22 txog 1.76, p<0.001; table="" 2).="" although="" nhb="" adults="" were="" less="" likely="" to="" recover="">raummuaj nuj nqitshaj NHW cov neeg laus (sub-HR 0.52; 95 feem pua ​​​​CI 0.51 rau 0.53, p<0.001), there="" was="" no="" statistically="" significant="" difference="" between="" the="" recovery="" rates="" in="" nhb="" and="" nhw="" children="" (sub-hr="" 1.00;="" 95%="" ci="" 0.79="" to="" 1.27, p="0.98)." starting="" outpatient="" dialysis="" with="" peritoneal="" dialysis="" was="" associated="" with="" a="" lower="" hazard="" of="" recovery="" compared="" with="" hemodialysis="" in="" both="" children="" and="" adults,="" but="" the="" effect="" size="" was="" more="" pronounced="" in="" adults="" (sub-hr="" 0.33;="" 95%="" ci="" 0.31="" to=""><0.001) compared="" with="" children="" (sub-hr="" 0.65;="" 95%="" ci="" 0.54="" to=""><0.001). similar="" findings="" were="" noted="" when="" the="" outcome="" of="" recovery="" was="" followed="" until="" the="" end="" of="" the="" study="" (s2="">

CliskNtawm norau Part 2.