Orlić Lidija, Matić-Glazar Durdica, Sladoje-Martinović Branka
Odjel za nefrologiju i dijalizu, Klinika za internu medicinu, Klinicki bolnicki centar Rijeka, Hrvatska.
Acta Med Croatica. 2006 Jun;60(3):287-91.
Today, the elderly are a fast growing population. Ever more patients aged > or = 65 are starting dialysis treatment. It is understood the they are a special and more sensitive group, due to their age and comorbid diseases. The aim of the study was to analyze the correlation of albumin, hemoglobin, cholesterol concentration and comorbid diseases at the beginning of treatment on the survival of patients aged > or = 65 years.
Sixty-one patients starting hemodialysis (31 male and 30 female) were followed-up between January 1, 1995 and December 31, 1999. There survival was monitored until June 30, 2002. Study patients were divided in four groups according to years of survival: group 1--patients who died during the first year of treatment; group 2--patients who died in the second year of treatment; group 3--patients still alive in the third year up the fifth year of treatment; group 4--patients with >5-year survival. Group 1 had 17 patients (9 male and 8 female), mean age 71.4 +/- 4.3 years; group 2 15 patients (7 male and 8 female), mean age 71.2 +/- 3.9 years; group 3 25 patients (13 male and 12 female), mean age 70.3 +/- 4.4 years; group 4 four patients (two male and two female), mean age 71.0 +/- 5.0 years. There was no significant age difference among the groups. All patients received regular hemodialysis for 4 hours, three times per week. Cellulose diacetate membranes and bicarbonate dialysate were used in all patients.
The mean albumin value (g/L) at the beginning of dialysis was 31.9 +/- 5.9* in group 1, 35.3 +/- 6.4 in group 2, 38.1 +/- 6.6 in group 3, 41.8 +/- 6.7* in group 4 (p=0.017). The mean hemoglobin (g/L) value at the beginning of dialysis was 81.1 +/-14.3* in group 1, 85.7 +/- 20.5 in group 2, 86.4 +/- 14.5 in group 3, and 97.2 +/- 6.2* in group 4 (p=0.021). The mean cholesterol value (mmol/L) at the beginning of dialysis was 4.7 +/-1.1* in group 1, 5.1 +/- 1.8 in group 2, 5.2 +/- 1.5 in group 3, and 5.1 +/- 0.7* in group 4 (p=0.072). The greatest number of comorbid diseases were recorded in patients surviving for one year (4.6 +/- 1.2) and lowest in those surviving for more than five years (1.5 +/- 0.6) (p=0.001). In group 1, 70.6% of patients had five and more comorbid diseases. In group 2, 3 and 4, there were no statistically significant changes in albumin, cholesterol and hemoglobin concentrations during the first six months. Cardiac and cerebrovascular diseases were the most common cause of death.
Accordingly, shorter survival of elderly patients on hemodialysis correlated with lower albumin and hemoglobin values at the beginning of treatment. Also, patients with shorter survival rates had lower cholesterol values, however, without statistically significant differences. During the six month period there was no significant albumin increase in study patients. Shorter survival was associated with higher comorbidity. It is concluded that patients having appropriate albumin, hemoglobin and cholesterol values on starting dialysis therapy have better prognosis.
如今，老年人是一个快速增长的群体。越来越多年龄≥65岁的患者开始接受透析治疗。由于他们的年龄和合并症，人们认为他们是一个特殊且更敏感的群体。本研究的目的是分析治疗开始时白蛋白、血红蛋白、胆固醇浓度和合并症与≥65岁患者生存情况的相关性。
1995年1月1日至1999年12月31日对61例开始血液透析的患者（31例男性和30例女性）进行了随访。监测他们的生存情况直至2002年6月30日。根据生存年限将研究患者分为四组：第1组——治疗第一年死亡的患者；第2组——治疗第二年死亡的患者；第3组——治疗第三年至第五年仍存活的患者；第4组——生存超过5年的患者。第1组有17例患者（9例男性和8例女性），平均年龄71.4±4.3岁；第2组15例患者（7例男性和8例女性），平均年龄71.2±3.9岁；第3组25例患者（13例男性和12例女性），平均年龄70.3±4.4岁；第4组4例患者（2例男性和2例女性），平均年龄71.0±5.0岁。各组之间年龄无显著差异。所有患者每周进行3次、每次4小时的常规血液透析。所有患者均使用醋酸纤维素膜和碳酸氢盐透析液。
透析开始时第1组的平均白蛋白值（g/L）为31.9±5.9*，第2组为35.3±6.4，第3组为38.1±6.6，第4组为41.8±6.7*（p = 0.017）。透析开始时第1组的平均血红蛋白（g/L）值为81.1±14.3*，第2组为85.7±20.5，第3组为86.4±14.5，第4组为97.2±6.2*（p = 0.021）。透析开始时第1组的平均胆固醇值（mmol/L）为4.7±1.1*，第2组为5.1±1.8，第3组为5.2±1.
