Yamamoto S, Kazama J J, Maruyama H, Nishi S, Narita I, Gejyo F
Division of Clinical Nephrology and Rheumatology, Niigata University Medical and Dental Hospital, Niigata, Japan.
Clin Nephrol. 2008 Dec;70(6):496-502. doi: 10.5414/cnp70496.
Increasing numbers of patients are undergoing long-term dialysis therapy. It is crucial for their quality of life to overcome dialysis-related complications, such as dialysis-related amyloidosis (DRA) and other osteoarticular disorder. The aim of the study was to investigate the characteristics, such as dialysis-related complications, in chronic kidney disease (CKD) Stage 5D patients undergoing dialysis therapy for more than 30 years or more.
From 2003 to 2006, 359 CKD Stage 5D patients who were admitted to a single tertiary-care center. The age and the duration of dialysis therapy, the purpose for hospital admission, and history of osteoarticular disorder, such as carpal tunnel syndrome (CTS), destructive spondyloarthropathy (DSA) and joint arthropathy, were studied.
The proportions of the patients undergoing dialysis therapy for 20 - 24, 25 - 29 years and 30 years or more were 8.9, 5.6, and 4.5% of all admitted patients, respectively. DSA was a major cause of hospital admissions in long-term dialysis patients, especially in those treated for 30 years or more. The rate of surgery for osteoarticular disorder, such as CTS, DSA and joint arthropathy, which may show the presence of DRA, was 25.0, 66.0 and 77.8% in 20 - 24 years, 25 - 29 years and 30 years or more after the initiation of dialysis therapy, respectively. The frequency and severity of osteoarticular disorder accelerated with the duration of dialysis therapy, especially in those treated for 30 years or more. The rate of parathyroidectomy for secondary hyperparathyroidism was performed for 37.5% in 22.1 +/- 2.1 years after the initiation of dialysis treatment in the patients treated for 30 years or more. Mean age at the initiation of dialysis therapy was 27.3 +/- 8.0 years, and primary cause of CKD was mainly chronic glomerulonephritis in the patients undergoing dialysis therapy for 30 years or more.
CKD stage 5D patients undergoing dialysis therapy for 30 years or more survive with characteristics of younger age at initiation of dialysis therapy, chronic glomerulonephritis as a primary cause of CKD, and serious complication of osteoarticular disorders.
接受长期透析治疗的患者数量日益增加。克服透析相关并发症，如透析相关性淀粉样变性（DRA）和其他骨关节疾病，对他们的生活质量至关重要。本研究的目的是调查接受透析治疗30年及以上的慢性肾脏病（CKD）5D期患者的透析相关并发症等特征。
2003年至2006年期间，359例CKD 5D期患者入住一家三级医疗中心。研究患者的年龄、透析治疗时长、入院目的以及骨关节疾病史，如腕管综合征（CTS）、破坏性脊椎关节病（DSA）和关节病。
接受透析治疗20 - 24年、25 - 29年以及30年及以上的患者比例分别占所有入院患者的8.9%、5.6%和4.5%。DSA是长期透析患者入院的主要原因，尤其是那些接受治疗30年及以上的患者。在透析治疗开始后20 - 24年、25 - 29年以及30年及以上，可能提示存在DRA的骨关节疾病（如CTS、DSA和关节病）的手术率分别为25.0%、66.0%和77.8%。骨关节疾病的频率和严重程度随着透析治疗时长而增加，尤其是那些接受治疗30年及以上的患者。在接受治疗30年及以上的患者中，透析治疗开始后22.1 +/- 2.1年因继发性甲状旁腺功能亢进进行甲状旁腺切除术的比例为37.5%。透析治疗开始时的平均年龄为27.3 +/- 8.0岁，接受透析治疗30年及以上的患者中CKD的主要病因主要是慢性肾小球肾炎。
接受透析治疗30年及以上的CKD 5D期患者存活下来时具有透析治疗开始时年龄较轻、CKD的主要病因是慢性肾小球肾炎以及骨关节疾病严重并发症等特征。
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