Han Seung Seok, Ryu Dong Ryeol, Joo Kwon Wook, Lim Chun Soo, Kim Yong Lim, Kang Shin Wook, Kim Yon Su, Kim Dong Ki
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
J Korean Med Sci. 2017 Sep;32(9):1460-1467. doi: 10.3346/jkms.2017.32.9.1460.
Despite the current knowledge about the risk of stroke and its related factors in general population, this issue in elderly patients receiving dialysis remains unresolved. Firstly, to compare the risk of stroke between hemodialysis (HD) and peritoneal dialysis (PD), data on 13,065 incident dialysis patients (aged ≥ 65 years; 10,675 in HD and 2,390 in PD) were retrieved from the Korean Health Insurance dataset. Secondly, to identify the risk factors of stroke amongst various clinical and laboratory parameters in HD, 980 elderly patients were retrospectively analyzed using an independent prospective cohort from 31 dialysis centers. For a mean duration of 1.8 years (maximum of 5 years), the risk of all cardiovascular diseases (ischemic heart disease and stroke) did not differ between HD and PD. However, when analyses were conducted separately by subtype, the risk of stroke, not ischemic heart disease, was significantly higher in HD patients than in PD patients. When the risk factors of stroke were probed after HD for a mean duration of 2.6 years (maximum of 7 years), the absolute dependence on social support, a previous history of cardiovascular disease, high levels of low-density lipoprotein cholesterol, and the use of a high number of anti-hypertensive drugs were identified as being significant. Based on the discrepancy of stroke risk between modalities and the HD-tailored risk factors of stroke, the monitoring and management of these factors may be a key strategy to reduce the risk of stroke in elderly patients receiving dialysis.
尽管目前已了解普通人群中中风风险及其相关因素，但老年透析患者的这一问题仍未得到解决。首先，为比较血液透析（HD）和腹膜透析（PD）患者的中风风险，从韩国健康保险数据集检索了13065例新发透析患者（年龄≥65岁；HD组10675例，PD组2390例）的数据。其次，为确定HD患者各种临床和实验室参数中的中风危险因素，使用来自31个透析中心的独立前瞻性队列对980例老年患者进行了回顾性分析。在平均1.8年（最长5年）的时间里，HD和PD患者的所有心血管疾病（缺血性心脏病和中风）风险并无差异。然而，按亚型分别分析时，HD患者中风风险显著高于PD患者，而非缺血性心脏病风险。在HD治疗平均2.6年（最长7年）后探究中风危险因素时，发现对社会支持的绝对依赖、心血管疾病病史、低密度脂蛋白胆固醇水平高以及使用多种抗高血压药物是显著危险因素。基于不同透析方式中风风险的差异以及HD特有的中风危险因素，对这些因素的监测和管理可能是降低老年透析患者中风风险的关键策略。
