Lister Renal Unit, Stevenage, Herts, United Kingdom.
Clin J Am Soc Nephrol. 2012 Dec;7(12):2002-9. doi: 10.2215/CJN.01130112. Epub 2012 Sep 6.
Benefits of dialysis in elderly dependent patients are not clearcut. Some patients forego dialysis, opting for conservative kidney management (CKM). This study prospectively compared quality of life and survival in CKM patients and those opting for dialysis.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Quality-of-life assessments (Short-Form 36, Hospital Anxiety and Depression Scale, and Satisfaction with Life Scale) were performed every 3 months for up to 3 years in patients with advanced, progressive CKD (late stage 4 and stage 5).
After 3 years, 80 and 44 of 170 patients had started or were planned for hemodialysis (HD) or peritoneal dialysis, respectively; 30 were undergoing CKM; and 16 remained undecided. Mean baseline estimated GFR ± SD was similar (14.0 ± 4.0 ml/min per 1.73 m(2)) in all groups but was slightly higher in undecided patients. CKM patients were older, more dependent, and more highly comorbid; had poorer physical health; and had higher anxiety levels than the dialysis patients. Mental health, depression, and life satisfaction scores were similar. Multilevel growth models demonstrated no serial change in quality-of-life measures except life satisfaction, which decreased significantly after dialysis initiation and remained stable in CKM. In Cox models controlling for comorbidity, Karnofsky performance scale score, age, physical health score, and propensity score, median survival from recruitment was 1317 days in HD patients (mean of 326 dialysis sessions) and 913 days in CKM patients.
Patients choosing CKM maintained quality of life. Adjusted median survival from recruitment was 13 months shorter for CKM patients than HD patients.
老年依赖患者进行透析的获益并不明确。部分患者选择放弃透析，转而接受保守肾脏管理（CKM）。本研究前瞻性比较了 CKM 患者与选择透析患者的生活质量和生存率。
设计、设置、参与者和测量：在晚期、进展性 CKD（晚期 4 期和 5 期）患者中，每 3 个月进行一次生活质量评估（SF-36、医院焦虑和抑郁量表以及生活满意度量表），最长可达 3 年。
3 年后，170 例患者中有 80 例和 44 例分别开始或计划进行血液透析（HD）或腹膜透析；30 例患者接受 CKM；16 例患者尚未决定。所有组别的基线估计肾小球滤过率（GFR）的平均值（14.0±4.0 ml/min/1.73 m2）相似，但未决定组的稍高。CKM 患者年龄更大、依赖性更高、合并症更多；身体状况更差；焦虑水平高于透析患者。心理健康、抑郁和生活满意度评分相似。多层次增长模型显示，除生活满意度外，所有生活质量测量指标均无连续变化，生活满意度在开始透析后显著下降，并在 CKM 中保持稳定。在控制合并症、Karnofsky 表现量表评分、年龄、身体健康评分和倾向评分的 Cox 模型中，从招募开始的中位生存时间为 HD 患者 1317 天（平均 326 次透析）和 CKM 患者 913 天。
选择 CKM 的患者维持了生活质量。从招募开始，CKM 患者的中位生存时间比 HD 患者缩短了 13 个月。
