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老年(80岁以上)腹膜透析患者的临床结局:两个中心的五年经验

Clinical outcomes in elderly (more than 80 years of age) peritoneal dialysis patients: five years' experience at two centers.

作者信息

Otowa Takanori, Sakurada Tsutomu, Nagasawa Motonori, Shimizu Sayaka, Yokoyama Takeshi, Kaneshiro Nagayuki, Konno Yusuke, Shibagaki Yugo, Kimura Kenjiro

机构信息

Division of Nephrology and Hypertension, Kawasaki Municipal Tama Hospital, Kawasaki, Japan.

Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Kawasaki, Japan.

出版信息

Adv Perit Dial. 2013;29:43-5.

Abstract

The proportion of elderly people requiring renal replacement therapy has been increasing in Japan. Although several studies have shown the benefits of peritoneal dialysis (PD) in the elderly, few have reported on outcomes, including prognosis, in elderly PD patients, especially those more than 80 years of age. The purpose of the present study was to evaluate clinical outcomes in elderly (more than 80 years of age) PD patients. We retrospectively evaluated the medical records of elderly PD patients who commenced PD between 2007 and 2011. The frequency of perioperative complications, rate of PD-associated peritonitis, technique survival, overall survival, and utilization of nursing-care insurance systems were investigated as clinical outcomes. The 12 patients eligible for this study (7 men, 5 women; mean age: 85 +/- 3 years) had a median duration of follow-up of 1.2 years (interquartile range: 0.65-1.74 years). Perioperative complications were not observed in any of the patients. The frequency of PD-associated peritonitis was 1 episode in 56 months. During follow-up, 6 patients died, and 3 patients switched to hemodialysis because of tunnel infection or lack of family support. The overall survival rate at 12 months was 83%. Nursing-care insurance was used by 63% of patients. In elderly patients, it is important to predict the potential short-term issues at the initiation of PD to facilitate implementation of social services, such as home-visit nursing-care services, at the time of worsening general condition.

摘要

在日本,需要肾脏替代治疗的老年人比例一直在增加。尽管多项研究表明腹膜透析(PD)对老年人有益,但很少有研究报道老年PD患者的预后等结局,尤其是80岁以上的患者。本研究的目的是评估老年(80岁以上)PD患者的临床结局。我们回顾性评估了2007年至2011年间开始进行PD治疗的老年PD患者的病历。调查围手术期并发症的发生频率、PD相关腹膜炎的发生率、技术生存率、总生存率以及护理保险系统的使用情况作为临床结局。符合本研究条件的12例患者(7例男性,5例女性;平均年龄:85±3岁)的中位随访时间为1.2年(四分位间距:0.65 - 1.74年)。所有患者均未观察到围手术期并发症。PD相关腹膜炎的发生频率为每56个月1次。随访期间,6例患者死亡,3例患者因隧道感染或缺乏家庭支持而转为血液透析。12个月时的总生存率为83%。63%的患者使用了护理保险。对于老年患者,在开始PD治疗时预测潜在的短期问题很重要,以便在一般状况恶化时促进社会服务的实施,如上门护理服务。

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