Prakash Jai, Hota J K, Singh S, Sharma O P
Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, India.
Int Urol Nephrol. 2006;38(3-4):821-7. doi: 10.1007/s11255-006-9003-y. Epub 2006 Nov 10.
The aim of this study was to describe the clinical spectrum of chronic renal failure (CRF) in the elderly. The diagnosis of CRF was made using standard clinical criteria. The elderly was defined as person with over 60 years of age. In total, 200 elderly patients with CRF were evaluated between July 2002 and February 2004. Their age (male: 146; female: 54) ranged between 60 and 90 (mean 64.31+/-4.18) years. Diabetic nephropathy was the most common (46%) cause of CRF. Hypertensive nephrosclerosis, chronic interstitial nephritis and obstructive uropathy were responsible for CRF in 18%, 14% and 13% of patients, respectively. We observed chronic glomerulonephritis in 7% of elderly CRF. Urinary tract infection (55.5%), hypovolemia (22.2%), accelerated hypertension (11.1%) and sepsis (11.1%) were responsible for acute exacerbation of renal failure in 36 (18%) patients. Associated co-morbid conditions were noted in 93 (46.5%) patients. They included; coronary artery disease 46 (49.46%), cerebrovascular disease 20 (21.50%), osteoarthritis 13 (13.97%), chronic obstructive pulmonary disease 6 (6.45%), dilated cardiomyopathy 5 (5.37%), and malignancy in 3 (3.22%) patients. Acute dialytic support was required in 164 (82%) cases and remaining 36 (18%) patients received conservative management. Mortality was noted in 25 (12.5%) cases. The coronary artery disease (48%), acute pulmonary edema (20%) and hyperkalemia (12%) were the main causes of death. Subsequent evaluation revealed that 102 (51%) patients had ESRD of which only 3 (2.94%) patients could afford CAPD. A total of 11 (10.7%) patients underwent chronic maintenance hemodialysis for 3-4 months and then discontinue dialysis mainly because of financial constraints. Remaining 88 (86.27 %) patients with ESRD were discharged from hospital after symptomatic improvement with acute dialysis. Thus, diabetic nephropathy related to type-2 diabetes was the commonest cause of CRF in our elderly patients. Chronic renal failure in elderly was associated with a number of co-morbid conditions, which contributed significantly to morbidity and mortality. Acute on chronic renal failure with severe uremic complications were an important cause of hospitalization. The financial constraint was the major limiting factor for the management of elderly ESRD patients.
本研究的目的是描述老年人慢性肾衰竭（CRF）的临床谱。CRF的诊断采用标准临床标准。老年人定义为年龄超过60岁的人。2002年7月至2004年2月期间，共评估了200例老年CRF患者。他们的年龄（男性146例；女性54例）在60至90岁之间（平均64.31±4.18岁）。糖尿病肾病是CRF最常见的病因（46%）。高血压性肾硬化、慢性间质性肾炎和梗阻性尿路病分别导致18%、14%和13%的患者发生CRF。我们在7%的老年CRF患者中观察到慢性肾小球肾炎。36例（18%）患者肾衰竭急性加重的原因是尿路感染（55.5%）、血容量不足（22.2%）、急进性高血压（11.1%）和脓毒症（11.1%）。93例（46.5%）患者存在相关合并症。其中包括；冠状动脉疾病46例（49.46%）、脑血管疾病20例（21.50%）、骨关节炎13例（13.97%）、慢性阻塞性肺疾病6例（6.45%）、扩张型心肌病5例（5.37%）、恶性肿瘤3例（3.22%）。164例（82%）患者需要急性透析支持，其余36例（18%）患者接受保守治疗。25例（12.5%）患者死亡。冠状动脉疾病（48%）、急性肺水肿（20%）和高钾血症（12%）是主要死亡原因。后续评估显示，102例（51%）患者患有终末期肾病（ESRD），其中只有3例（2.94%）患者能够负担持续性非卧床腹膜透析（CAPD）。共有11例（10.7%）患者接受了3至4个月的维持性血液透析，然后主要由于经济限制而停止透析。其余88例（86.27%）ESRD患者在急性透析症状改善后出院。因此，2型糖尿病相关的糖尿病肾病是我们老年患者CRF最常见的病因。老年慢性肾衰竭与多种合并症相关，这些合并症对发病率和死亡率有显著影响。慢性肾衰竭急性加重伴严重尿毒症并发症是住院的重要原因。经济限制是老年ESRD患者治疗的主要限制因素。
