Renal Unit, Lister Hospital, Stevenage, Hertfordshire SG1 4AB, UK.
Nephrol Dial Transplant. 2011 May;26(5):1608-14. doi: 10.1093/ndt/gfq630. Epub 2010 Nov 22.
Elderly patients with end-stage renal disease and severe extra-renal comorbidity have a poor prognosis on renal replacement therapy (RRT) and may opt to be managed conservatively (CM). Information on the survival of patients on this mode of therapy is limited.
We studied survival in a large cohort of CM patients in comparison to patients who received RRT.
Over an 18-year period, we studied 844 patients, 689 (82%) of whom had been treated by RRT and 155 (18%) were CM. CM patients were older and a greater proportion had high comorbidity. Median survival from entry into stage 5 chronic kidney disease was less in CM than in RRT (21.2 vs 67.1 months: P < 0.001). However, in patients aged > 75 years when corrected for age, high comorbidity and diabetes, the survival advantage from RRT was ~ 4 months, which was not statistically significant. Increasing age, the presence of high comorbidity and the presence of diabetes were independent determinants of poorer survival in RRT patients. In CM patients, however, age > 75 years and female gender independently predicted better survival.
In patients aged > 75 years with high extra-renal comorbidity, the survival advantage conferred by RRT over CM is likely to be small. Age > 75 years and female gender predicted better survival in CM patients. The reasons for this are unclear.
患有终末期肾病和严重肾外合并症的老年患者在接受肾脏替代治疗 (RRT) 时预后较差，可能选择保守治疗 (CM)。关于这种治疗模式下患者的生存情况的信息有限。
我们研究了在大规模 CM 患者队列中的生存情况，并将其与接受 RRT 的患者进行了比较。
在 18 年的时间里，我们研究了 844 名患者，其中 689 名（82%）接受了 RRT 治疗，155 名（18%）接受了 CM 治疗。CM 患者年龄较大，合并症比例较高。从进入 5 期慢性肾脏病开始，CM 患者的中位生存期短于 RRT 患者（21.2 与 67.1 个月：P < 0.001）。然而，在 > 75 岁的患者中，当按年龄、高合并症和糖尿病校正后，RRT 的生存优势约为 4 个月，但无统计学意义。年龄增加、高合并症和糖尿病的存在是 RRT 患者生存较差的独立决定因素。然而，在 CM 患者中，年龄 > 75 岁和女性独立预测生存更好。
在高肾外合并症的 > 75 岁患者中，RRT 相对于 CM 的生存优势可能较小。年龄 > 75 岁和女性预测 CM 患者的生存更好。其原因尚不清楚。
