Hospital Gregorio Marañón, Madrid, Spain.
Nephron Clin Pract. 2010;115(1):c28-34. doi: 10.1159/000286347. Epub 2010 Feb 19.
Elderly patients are increasingly enrolled in dialysis programs and present a series of special characteristics due to their high morbidity and mortality.
To describe the characteristics of incident dialysis patients aged >75 years, their comorbidities and their admissions, with a view to determining the factors that influence their course and mortality.
The study included all patients aged >75 years who started dialysis in our center since January 2000. The mean duration of follow-up was 3.3 +/- 2.2 years. Data were collected on incident comorbidity, admissions and their causes. A total of 139 patients were included, with a mean age of 78.6 +/- 2.6 years (67.6% males, 33.8% diabetic and 7.9% on peritoneal dialysis). Three groups were established according to age: 75-79, 80-85 and >85 years. The most frequent comorbidities were chronic obstructive pulmonary disease (25.9%), ischemic heart disease (25.2%), heart failure (25.9%), neoplasms (23.7%), peripheral vascular disease (23.7%), cerebrovascular disease (18.7%) and arterial hypertension (81%). The Charlson index was calculated, not adjusted for age, and comorbidity tertiles were established.
During follow-up, the patients presented 0.82 +/- 0.99 admissions/patient/year, with a duration of 12.1 +/- 20.6 days/patient/year. The main causes of admission were infection (33%), vascular access problems (27%) and peripheral vascular events (14%). A total of 61 patients died (44%), and 4 underwent kidney transplantation (2.9%). The mean duration of follow-up of the transplanted patients was 3.6 +/- 1.8 years. The main causes of death were infection (32%), cardiovascular problems (28.3%) and neoplastic disease (11.3%). The global survival rate was 90, 82 and 53% after 1, 2 and 5 years, respectively. No significant differences in survival or annual admission rate were found in relation to age group and dialysis technique. In contrast, the annual admission rate and days of admission were directly correlated to the Charlson index (p = 0.009 and p = 0.032, respectively). No significant differences in the Charlson index were found between the patients on hemodialysis and those subjected to peritoneal dialysis. In the univariate model, the factors associated to mortality were diabetes, chronic obstructive pulmonary disease, heart failure and the Charlson index. In the multivariate model, only the Charlson index remained as an independent predictive factor (p = 0.006).
Unlike the general population, age does not influence mortality or admissions in elderly patients on dialysis. Incident comorbidity is the factor exerting the greatest influence upon mortality and admissions. Advanced age in itself should not be regarded as an excluding factor for starting dialysis.
描述起始透析时年龄>75 岁的老年患者的特征、合并症及住院情况，以确定影响其病程和死亡率的因素。
该研究纳入了自 2000 年 1 月以来在我院开始透析的所有年龄>75 岁的患者。平均随访时间为 3.3±2.2 年。收集了起始合并症、住院情况及其原因的数据。共纳入 139 例患者，平均年龄 78.6±2.6 岁（67.6%为男性，33.8%为糖尿病患者，7.9%接受腹膜透析）。根据年龄分为 3 组：75-79 岁、80-85 岁和>85 岁。最常见的合并症为慢性阻塞性肺疾病（25.9%）、缺血性心脏病（25.2%）、心力衰竭（25.9%）、肿瘤（23.7%）、外周血管疾病（23.7%）、脑血管疾病（18.7%）和高血压（81%）。计算了未调整年龄的 Charlson 指数，并建立了合并症三分位数。
在随访期间，患者每年每例发生 0.82±0.99 次住院，住院天数为 12.1±20.6 天/例/年。住院的主要原因是感染（33%）、血管通路问题（27%）和外周血管事件（14%）。共有 61 例患者死亡（44%），4 例患者接受了肾移植（2.9%）。移植患者的平均随访时间为 3.6±1.8 年。死亡的主要原因是感染（32%）、心血管问题（28.3%）和肿瘤疾病（11.3%）。移植患者的 1、2 和 5 年总体生存率分别为 90%、82%和 53%。年龄组和透析技术与生存率或年住院率均无显著差异。相反，Charlson 指数与年住院率和住院天数呈正相关（p=0.009 和 p=0.032）。血液透析和腹膜透析患者的 Charlson 指数无显著差异。单因素模型中，与死亡率相关的因素为糖尿病、慢性阻塞性肺疾病、心力衰竭和 Charlson 指数。多因素模型中，只有 Charlson 指数是独立的预测因素（p=0.006）。
与一般人群不同，在开始透析的老年患者中，年龄并不影响死亡率或住院率。起始合并症是影响死亡率和住院率的最大因素。高龄本身不应作为开始透析的排除因素。
