Hayes John S, Balogun Rasheed A, Chang Jamison, Abdel-Rahman Emaad M
Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia 22908, USA.
Semin Dial. 2012 Mar-Apr;25(2):159-64. doi: 10.1111/j.1525-139X.2011.01027.x. Epub 2012 Jan 25.
The elderly people, 65 years old and above, are growing in number. The structural and functional changes associated with aging place the elderly at risk when challenged by extracorporeal therapies, such as therapeutic plasma exchange (TPE). We retrospectively analyzed data on all patients who underwent TPE for renal indications at our institution between January 1, 2000 and June 30, 2010 and compared renal indications and mortality associated with the use of TPE in older versus younger patients. During this period, 621 patients underwent 4722 sessions of TPE. Of them, 191 patients were elderly (30.7%) and they underwent 1289 sessions (27.3%) of TPE. A total of 104 patients (16.7%) underwent 593 sessions of TPE because of renal-related indications: 26 patients in the elderly group and 78 in the younger. Side effects of dyspnea and hypotension were documented in only two patients, both in the elderly cohort. The main indication for TPE in the elderly was glomerulonephritis (GN) as compared with renal allograft rejection in the younger cohort, with a trend toward more death in the elderly (p = 0.07). The multivariable regression model which included age as a category, serum albumin, and initial serum creatinine were unable to predict mortality in this group of patients. In our experience, the main renal indications for TPE in elderly are different from those for younger patients, with GN being the most common renal indication in the elderly. The TPE used for renal indications in the elderly is relatively safe. Trends toward death in the elderly may be multifactorial and not necessarily related to TPE.
65岁及以上的老年人数量正在增加。与衰老相关的结构和功能变化使老年人在接受体外治疗（如治疗性血浆置换术（TPE））时面临风险。我们回顾性分析了2000年1月1日至2010年6月30日期间在我院因肾脏适应证接受TPE治疗的所有患者的数据，并比较了老年患者和年轻患者使用TPE的肾脏适应证及死亡率。在此期间，621例患者接受了4722次TPE治疗。其中，191例患者为老年人（30.7%），他们接受了1289次（27.3%）TPE治疗。共有104例患者（16.7%）因肾脏相关适应证接受了593次TPE治疗：老年组26例，年轻组78例。仅在老年队列中的两名患者记录到呼吸困难和低血压的副作用。老年患者TPE的主要适应证是肾小球肾炎（GN），而年轻队列中是肾移植排斥，老年患者有更高的死亡趋势（p = 0.07）。包含年龄类别、血清白蛋白和初始血清肌酐的多变量回归模型无法预测该组患者的死亡率。根据我们的经验，老年患者TPE的主要肾脏适应证与年轻患者不同，GN是老年患者最常见的肾脏适应证。用于老年患者肾脏适应证的TPE相对安全。老年患者的死亡趋势可能是多因素的，不一定与TPE有关。
