Kurella Manjula, Covinsky Kenneth E, Collins Alan J, Chertow Glenn M
Division of Nephrology, University of California, San Francisco, CA 94118-1211, USA.
Ann Intern Med. 2007 Feb 6;146(3):177-83. doi: 10.7326/0003-4819-146-3-200702060-00006.
The elderly constitute the fastest-growing segment of the end-stage renal disease (ESRD) population, but the epidemiology and outcomes of dialysis among the very elderly, that is, those 80 years of age and older, have not been previously examined at a national level.
To describe recent trends in the incidence and outcomes of octogenarians and nonagenarians starting dialysis.
Observational study.
U.S. Renal Data System, a comprehensive, national registry of patients with ESRD.
Octogenarians and nonagenarians initiating dialysis between 1996 and 2003.
Rates of dialysis initiation and survival.
The number of octogenarians and nonagenarians starting dialysis increased from 7054 persons in 1996 to 13,577 persons in 2003, corresponding to an average annual increase in dialysis initiation of 9.8%. After we accounted for population growth, the rate of dialysis initiation increased by 57% (rate ratio, 1.57 [95% CI, 1.53 to 1.62]) between 1996 and 2003. One-year mortality for octogenarians and nonagenarians after dialysis initiation was 46%. Compared with octogenarians and nonagenarians initiating dialysis in 1996, those starting dialysis in 2003 had a higher glomerular filtration rate and less morbidity related to chronic kidney disease but no difference in 1-year survival. Clinical characteristics strongly associated with death were older age, nonambulatory status, and more comorbid conditions.
Survival of patients with incident ESRD who did not begin dialysis could not be assessed.
The number of octogenarians and nonagenarians initiating dialysis has increased considerably over the past decade, while overall survival for patients on dialysis remains modest. Estimates of prognosis based on patient characteristics, when considered in conjunction with individual values and preferences, may aid in dialysis decision making for the very elderly.
老年人是终末期肾病（ESRD）患者群体中增长最快的部分，但此前尚未在国家层面研究过80岁及以上高龄老年人的透析流行病学及预后情况。
描述80岁及90岁以上老年人开始透析的发病率及预后的近期趋势。
观察性研究。
美国肾脏数据系统，一个全面的全国ESRD患者登记系统。
1996年至2003年间开始透析的80岁及90岁以上老年人。
透析开始率和生存率。
开始透析的80岁及90岁以上老年人数量从1996年的7054人增加到2003年的13577人，相应的透析开始平均年增长率为9.8%。在考虑人口增长因素后，1996年至2003年间透析开始率增加了57%（率比为1.57[95%CI，1.53至1.62]）。80岁及90岁以上老年人透析开始后的1年死亡率为46%。与1996年开始透析的80岁及90岁以上老年人相比，2003年开始透析的患者肾小球滤过率更高，慢性肾病相关发病率更低，但1年生存率无差异。与死亡密切相关的临床特征包括年龄较大、非活动状态和更多的合并症。
无法评估未开始透析的初发ESRD患者的生存率。
在过去十年中，开始透析的80岁及90岁以上老年人数量大幅增加，而透析患者的总体生存率仍然不高。结合个体价值观和偏好考虑基于患者特征的预后估计，可能有助于为高龄老年人做出透析决策。
