University Hospital Arcispedale Sant'Anna, Ferrara, Italy.
J Nephrol. 2010 Sep-Oct;23 Suppl 15:S90-7.
Management of chronic uremia in elderly patients presents several clinic and organizational difficulties. Hemodialysis (HD) and chronic peritoneal dialysis (CPD) are both available for the elderly, and the choice depends on the individual, clinical and familial conditions. Several reports have compared the outcomes for older patients treated by HD or peritoneal dialysis, with those for younger or older patients undergoing peritoneal dialysis. CPD is a successful dialysis option for elderly patients, in both patient and technique survival terms. All nutritional parameters are of pivotal importance. Several barriers, such as medical and social factors, physician bias, late referral and education irrespective of the needs of older patients, influence the choice of CPD. The development of assisted peritoneal dialysis, using community-based nurses or health care assistants, can overcome some of the barriers and enable frail older patients to have home-based dialysis treatment. Increasing age is associated with higher peritonitis rates among patients who started CPD in the 1990s, while age is not associated with peritonitis in more recent CPD cohorts, and no greater frequency of adverse outcomes of peritonitis has been seen among those who began CPD after the year 2000. In elderly dialysis patients, the management of quality of life (QOL) is important as well as adequacy of dialysis, nutritional status and survival rate. To obtain a good standard of QOL, it is essential to select carers who are properly educated and who can access an adequate support system, both physical and psychological, to help them cope with their burden.
老年慢性尿毒症患者的管理存在一些临床和组织方面的困难。血液透析（HD）和慢性腹膜透析（CPD）均可用于老年患者，具体选择取决于个人、临床和家庭状况。有几项报告比较了 HD 或腹膜透析治疗的老年患者与接受腹膜透析的年轻或老年患者的结局。CPD 是老年患者成功的透析选择，无论是在患者生存率还是技术生存率方面。所有营养参数都至关重要。一些障碍，如医疗和社会因素、医生偏见、延迟转诊和教育，无论老年患者的需求如何，都会影响 CPD 的选择。使用社区护士或保健助理的辅助腹膜透析的发展可以克服一些障碍，使体弱的老年患者能够在家中进行透析治疗。在 20 世纪 90 年代开始接受 CPD 的患者中，随着年龄的增长，腹膜炎的发生率更高，而在最近的 CPD 队列中，年龄与腹膜炎无关，在 2000 年后开始接受 CPD 的患者中，腹膜炎的不良后果频率也没有增加。在老年透析患者中，管理生活质量（QOL）与透析充分性、营养状况和生存率同样重要。为了获得良好的 QOL 标准，必须选择受过适当教育的护理人员，并为他们提供充足的支持系统，包括身体和心理方面的支持，以帮助他们应对负担。
