MBBS, Division of Geriatrics, Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China.
J Gerontol A Biol Sci Med Sci. 2014 Mar;69(3):308-14. doi: 10.1093/gerona/glt098. Epub 2013 Aug 2.
Data on the outcomes of older adults receiving peritoneal dialysis (PD), especially those who are dependent and have multiple comorbidities, are scarce.
In a retrospective cohort study, we compared older adults (≥65 years) with stage 5 chronic kidney disease receiving PD (PD group) with those receiving conservative management (conservative group). Baseline characteristics (demographics and clinical, functional, socioeconomic, and laboratory parameters) were collected, and study outcomes (patient survival, emergency hospitalization, institutionalization, and palliative and end-of-life care) were compared between groups.
We included 199 eligible participants aged 65-90 years (mean ± standard deviation 73.8 ± 5.4 years; 157 in the PD group and 42 in the conservative group). The PD group had a longer survival (median [interquartile range]: 3.75 [2.49-5.25] vs 2.35 [1.13-3.71] years, p < .001), lower emergency hospitalization rates (1.63 [0.82-2.92] vs 3.51 [1.06-7.16] per person-year, p < .01) and hospital days (16.17 [6.29-43.32] vs 38.01 [6.75-76.56] days per person-year, p = .03), and no increased risk of institutionalization compared with the conservative group. Age (hazard ratio [HR] for 1-year increase 1.06, 95% confidence interval [CI] 1.02-1.10), modified Charlson's Comorbidity Index (HR 1.36, 95% CI 1.18-1.56), impairment in basic activities of daily living (HR 2.11, 95% CI 1.28-3.46), and emergency dialysis (HR 1.67, 95% CI 1.11-2.53) were independent predictors of mortality in the PD group.
PD is a viable treatment option in older adults with stage 5 chronic kidney disease. Age alone should not preclude dialysis. Comprehensive geriatric assessment can prognosticate and facilitate shared decision making to commence dialysis in older adults.
关于接受腹膜透析（PD）的老年患者（尤其是依赖且合并多种合并症的患者）结局的数据十分有限。
在一项回顾性队列研究中，我们比较了接受 PD（PD 组）和保守治疗（保守组）的 5 期慢性肾脏病老年患者（≥65 岁）。收集了基线特征（人口统计学和临床、功能、社会经济和实验室参数），并比较了两组的研究结局（患者生存、急诊住院、机构化、姑息和临终关怀）。
我们纳入了 199 名符合条件的 65-90 岁患者（平均±标准差 73.8±5.4 岁；PD 组 157 例，保守组 42 例）。PD 组的生存时间更长（中位数[四分位间距]：3.75[2.49-5.25]年 vs 2.35[1.13-3.71]年，p<0.001），急诊住院率更低（1.63[0.82-2.92]人年 vs 3.51[1.06-7.16]人年，p<0.01）和住院天数更少（16.17[6.29-43.32]人年 vs 38.01[6.75-76.56]人年，p=0.03），与保守组相比，机构化的风险无增加。与 1 年增加 1 岁相比，年龄（每增加 1 岁的风险比[HR]1.06，95%置信区间[CI]1.02-1.10）、改良 Charlson 合并症指数（HR 1.36，95%CI 1.18-1.56）、日常生活基本活动能力受损（HR 2.11，95%CI 1.28-3.46）和急诊透析（HR 1.67，95%CI 1.11-2.53）是 PD 组死亡的独立预测因素。
PD 是 5 期慢性肾脏病老年患者的一种可行的治疗选择。仅年龄不应排除透析。全面的老年评估可以预测并促进在老年患者中开始透析的共同决策。
