Apostolou Theofanis
Internal Medicine and Nephrology, Department of Nephrology, Evangelismos General Hospital, Athens, Greece.
Int Urol Nephrol. 2007;39(2):679-83. doi: 10.1007/s11255-007-9225-7. Epub 2007 May 24.
The pattern of end-stage renal disease (ESRD) has changed significantly with the emerging predominance of elderly patients. Age is no longer seen as a contraindication to dialysis. Based on 2004 data, in the USA, patients aged 45-64 years old comprise the largest portion of the incident population, while patients aged 75 and older have the highest incident rates of ESRD. Mortality is higher among the elderly dialysis patients for whom cardiovascular diseases and infections are the most common causes of death. The quality of life (QoL) of these patients has been found to vary in different investigations, dependent on such factors as the investigator(s), the composition of the study group and the criteria used, among others; however, age was always found one of the major determinants of their QoL. Quality-of-life data suggest that older dialysis patients have similar levels of social functioning and mental health as younger dialysis patients but that their level of physical functioning is poorer. As such, the survival and QoL of elderly patients depends mainly on the severity of the comorbid conditions. The rationing of dialysis on the basis of age alone is not justified as dialysis can provide elderly patients with the means to gain the health status that permits them to enjoy life, but in their own way.
随着老年患者逐渐占据主导地位，终末期肾病（ESRD）的模式发生了显著变化。年龄不再被视为透析的禁忌证。根据2004年的数据，在美国，45至64岁的患者占新发病例人群的最大比例，而75岁及以上的患者ESRD发病率最高。老年透析患者的死亡率较高，心血管疾病和感染是其最常见的死亡原因。在不同的调查中发现，这些患者的生活质量（QoL）有所不同，这取决于调查者、研究组的构成以及所使用的标准等因素；然而，年龄始终被认为是其生活质量的主要决定因素之一。生活质量数据表明，老年透析患者的社会功能和心理健康水平与年轻透析患者相似，但身体功能水平较差。因此，老年患者的生存和生活质量主要取决于合并症的严重程度。仅基于年龄进行透析配给是不合理的，因为透析可以为老年患者提供获得健康状态的手段，使他们能够以自己的方式享受生活。
