Lapeyronie University Hospital, CHU Montpellier University, Montpellier, France.
Clin J Am Soc Nephrol. 2011 Jul;6(7):1651-62. doi: 10.2215/CJN.03530410.
Demand for hemodialysis among elderly patients is increasing worldwide. Although clinical care of this high-risk group is complex and challenging, no guidelines exist to inform hemodialysis practices. The Dialysis Outcomes and Practice Patterns Study (DOPPS) provides a unique opportunity to assess dialysis practices and associated outcomes among elderly versus younger patients on chronic in-center hemodialysis in 12 countries.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Clinical characteristics, dialysis practices, and outcomes of elderly versus younger patients were compared among participants in four DOPPS regions in 2005 through 2007.
Although participant mean age increased over time in all DOPPS countries, the percentage of elderly varied widely. Overall, comorbidities and malnutrition were more common in the elderly. Fistulae were used less frequently among elderly versus younger patients in Europe and North America but not in Australia, New Zealand, and Japan. No difference in treatment time was observed between elderly and younger patients after normalizing for body weight. In all regions, ultrafiltration rates were lower among elderly patients. Elderly patients reported poorer quality of life with respect to the physical but not mental component scores. Mortality risk was three- to sixfold higher in the elderly group, whereas causes of death overall were similar for elderly and younger patients.
Elderly patients represent a different proportion of DOPPS participants across countries, possibly reflecting differences in policies and clinical practices. In general, hemodialysis practices in the elderly reflected each region's clinical patterns, with some variation by age group depending upon the practice.
全球范围内老年患者对血液透析的需求正在增加。尽管对这一高危群体的临床护理较为复杂且具有挑战性，但目前尚不存在相关指南来指导血液透析实践。透析结果和实践模式研究（DOPPS）为评估 12 个国家 12 个地区慢性中心血液透析中老年患者与年轻患者的透析实践和相关结局提供了一个独特的机会。
设计、设置、参与者和测量方法：比较了 2005 年至 2007 年期间四个 DOPPS 地区的参与者中，老年患者与年轻患者的临床特征、透析实践和结局。
尽管所有 DOPPS 国家的参与者平均年龄均随时间推移而增加，但老年患者的比例差异较大。总体而言，老年患者合并症和营养不良更为常见。在欧洲和北美，瘘管在老年患者中的使用频率低于年轻患者，但在澳大利亚、新西兰和日本并非如此。在对体重进行归一化后，老年患者和年轻患者的治疗时间没有差异。在所有地区，老年患者的超滤率均较低。老年患者的生活质量在身体方面较差，但在精神方面则没有差异。老年患者的死亡风险是年轻患者的三到六倍，而老年患者和年轻患者的死亡原因总体上相似。
老年患者在不同国家的 DOPPS 参与者中所占比例不同，这可能反映了政策和临床实践的差异。一般来说，老年患者的血液透析实践反映了各地区的临床模式，而根据年龄组的不同，实践也有所不同。
