Renal Department, Imperial College Kidney and Transplant Centre, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
Nat Rev Nephrol. 2011 Aug 30;7(10):591-8. doi: 10.1038/nrneph.2011.113.
Elderly patients with end-stage renal disease (ESRD) are at increased risk of developing aging-related problems, such as frailty, impaired physical function, falls, poor nutrition and cognitive impairment. These factors affect dialysis outcomes, which can be very poor in frail, elderly patients who often experience a decline in overall health and physical function and have short survival. The default treatment option for these patients is hospital-based hemodialysis, often with little consideration of how this modality will affect the survival or quality of life of individual patients. A comparison of quality of life of elderly patients on hemodialysis versus peritoneal dialysis shows that those on peritoneal dialysis have less illness intrusion. Assisted peritoneal dialysis enables a greater number of frail, elderly patients to have dialysis in their own homes. Dialysis may not extend survival for those with multiple comorbidities, so conservative care (nondialysis treatment) should be considered. To improve the outcomes of elderly patients with ESRD, it is necessary to develop a realistic approach to overall prognosis, quality of life and how the patient copes with the disabilities associated with aging. This approach includes having discussions regarding choice of treatment and end-of-life goals with patients and families.
老年终末期肾病（ESRD）患者发生与衰老相关问题（如虚弱、身体机能受损、跌倒、营养不良和认知障碍）的风险增加。这些因素会影响透析结果，身体虚弱和高龄患者的透析结果通常非常差，他们的整体健康和身体机能常常下降，且存活时间较短。这些患者的默认治疗选择是住院血液透析，但很少考虑该治疗模式对个体患者的存活或生活质量的影响。对血液透析与腹膜透析老年患者的生活质量进行比较的结果显示，腹膜透析患者的疾病侵扰程度较低。辅助性腹膜透析使更多虚弱的老年患者能够在家中进行透析。对于患有多种合并症的患者，透析可能无法延长其存活时间，因此应考虑保守治疗（非透析治疗）。为改善 ESRD 老年患者的预后，有必要对整体预后、生活质量以及患者如何应对与衰老相关的残疾问题制定切合实际的方法。这种方法包括与患者及其家属讨论治疗选择和临终目标。
