Mansilla Francisco Juan José, Díez De los Ríos Cuenca Francisco, Cabrera Azaña Sandra, Cortés Torres Joaquín, Macías López M José, González Castillo José Antonio, Ferreras Duarte Juan Luís
School of Health Sciences, Nursing Faculty Málaga University, Málaga, Spain.
CANNT J. 2012 Jan-Mar;22(1):25-9.
The incidence of end stage renal disease in older persons has been increasing progressively over the last 10 years. Improved survival rates with renal replacement therapy are making this increased prevalence even more pronounced. The usual risks of morbidity and requirements for specialized care associated with older people increase dramatically when they have chronic kidney disease (CKD). It has been seen that the majority of patients in hemodialysis units are over the age of 60, and have significant co-morbidities. The relationship between older age, chronic disorders and functional dependence (FD) is well known. Accordingly, nursing care planning must be designed with this in mind. The aim of this study was to assess whether the comorbidity associated with CKD modifies FD in patients on hemodialysis. We undertook a prospective longitudinal cohort study of hemodialysis outpatients in Málaga, Spain, using the Barthel test to establish FD and the Charlson comorbidity index to quantify comorbidity. All health events were analyzed to select those study patients with incident comorbidity, understood as the appearance of a new disease that could modify the Charlson comorbidity index, and determine the change in FD. Multivariate linear regression showed that the best model for predicting functional loss was that which considered comorbidity adjusted for age, particularly when it occurred as a result of hospital admission, as it was shown to have an important predictive value for the onset of a decrease in functional dependency scores in patients with CKD.
在过去10年中，老年人终末期肾病的发病率一直在逐步上升。肾脏替代治疗生存率的提高使这种患病率的上升更加明显。当老年人患有慢性肾脏病（CKD）时，与老年人相关的常见发病风险和特殊护理需求会急剧增加。据观察，血液透析单位的大多数患者年龄超过60岁，且有明显的合并症。老年人、慢性疾病与功能依赖（FD）之间的关系是众所周知的。因此，护理计划的制定必须考虑到这一点。本研究的目的是评估与CKD相关的合并症是否会改变血液透析患者的功能依赖。我们对西班牙马拉加的血液透析门诊患者进行了一项前瞻性纵向队列研究，使用巴氏指数来确定功能依赖，并使用查尔森合并症指数来量化合并症。分析所有健康事件，以选择那些有新发合并症的研究患者，即被认为是可能改变查尔森合并症指数的新疾病的出现，并确定功能依赖的变化。多变量线性回归表明，预测功能丧失的最佳模型是考虑了年龄调整后的合并症的模型，特别是当合并症是由于住院引起时，因为它被证明对CKD患者功能依赖评分下降的发生具有重要的预测价值。
