Dialysis Access Group of Wake Forest University, Department of Internal Medicine/Nephrology and Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Clin J Am Soc Nephrol. 2011 Jul;6(7):1663-7. doi: 10.2215/CJN.05830710. Epub 2011 Jun 16.
Octogenarians frequently require maintenance hemodialysis (HD) for treatment of stage renal disease ESRD. Although the Fistula First Initiative recommends creating an arteriovenous fistula as the preferred dialysis access method, vascular access selection should be based on life expectancy and functional status at treatment initiation.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This is a retrospective analysis of 4-year outpatient data (January 1, 2004 through December 31, 2007) of incident octogenarian dialysis population in an academic institution. Thirty-nine of 268 patients were octogenarians with a mean (± SD) age of 83.4 ± 3.4 years, and 25 were men. Kaplan-Meier survival and Fisher's post hoc statistical analyses were performed.
Thirty-seven octogenarian patients selected HD and two selected peritoneal dialysis. Among the 37 HD patients, 29 initiated dialysis with a tunneled cuffed catheter, 6 with an arteriovenous fistula, and 2 with an arteriovenous graft. Three patients regained renal function after an average 112 days and one was lost to follow-up. Of the 33 remaining on HD, 8 required nursing home admission and 25 were discharged home after initiating HD. Among these 33, 19 died and 14 remained on HD at the end of study period. Days on dialysis (mean ± SEM) before death in those discharged to a nursing facility versus home were 52.6 ± 14.7 versus 386.1 ± 90.7 (P < 0.05), respectively.
Vascular access planning should include assessment of functional status and life expectancy in octogenarian HD patients.
八旬老人经常需要维持性血液透析（HD）来治疗终末期肾病（ESRD）。尽管“瘘管优先倡议”建议建立动静脉瘘作为首选的透析通路方法，但血管通路的选择应基于治疗开始时的预期寿命和功能状态。
设计、地点、参与者和测量方法：这是对一所学术机构 4 年门诊数据（2004 年 1 月 1 日至 2007 年 12 月 31 日）的回顾性分析，涉及八旬初发透析人群。268 例患者中有 39 例为 80 岁以上患者，平均（± SD）年龄为 83.4 ± 3.4 岁，其中 25 例为男性。进行了 Kaplan-Meier 生存分析和 Fisher 事后统计分析。
37 名八旬老人选择了 HD，2 名选择了腹膜透析。在 37 名接受 HD 的患者中，29 名患者开始透析时使用了带隧道的带套导管，6 名患者使用了动静脉瘘，2 名患者使用了动静脉移植物。3 名患者在平均 112 天后恢复了肾功能，1 名患者失访。在 33 名继续接受 HD 的患者中，8 名患者需要入住疗养院，25 名患者在开始 HD 后出院回家。在这 33 名患者中，19 人死亡，14 人在研究结束时仍在接受 HD 治疗。在被送往疗养院和回家的患者中，死亡前的透析天数（平均值± SEM）分别为 52.6 ± 14.7 天和 386.1 ± 90.7 天（P < 0.05）。
在接受 HD 的八旬老人中，血管通路规划应包括对功能状态和预期寿命的评估。
