Roy Debajyoti, Chowdhury Anupama Roy, Pande Shrikant, Kam Jia Wen
Changi General Hospital, 2 Simei St. 3, Singapore, 528889, Singapore.
Alexandra Health, 378 Alexandra Road, Singapore, 159964, Singapore.
BMC Nephrol. 2017 Dec 19;18(1):364. doi: 10.1186/s12882-017-0778-0.
Increasing numbers of elderly patients are undergoing long-term dialysis. However, the role of dialysis in survival and quality of life is unclear, and poor outcomes may be associated with comorbidities rather than with age only. The initiation of unplanned dialysis in elderly patients with chronic kidney disease (CKD) has been reported to be associated with poor survival. We evaluated patient and practice factors associated with poor survival.
We performed a retrospective analysis of 90 consecutive elderly patients (≥75 years) with CKD initiated on long-term dialysis at our renal unit between October 2010 and February 2014. Six patients were excluded; data from 84 remaining patients (≥75 years) with end-stage renal disease undergoing planned or unplanned dialysis were analyzed. Patients were followed up until death or January 2015. Patient factors such as age at initiation of dialysis and comorbidities (i.e., diabetes mellitus, ischemic heart disease [IHD], peripheral vascular disease, cancer, chronic obstructive pulmonary disease, and cognitive dysfunction) were analyzed. Practice factors such as planned or unplanned initiation of dialysis were compared in relation to survival outcomes. "Unplanned dialysis" was defined as a patient with known CKD stage 4 or 5 who had not been evaluated by a nephrologist in the 3 months before dialysis initiation.
The average age at dialysis initiation was 81.5 ± 4.5 years), serum albumin level was 24.8 ± 6 g/L, body mass index was 22.5 ± 4.8 kg/m, and glycated hemoglobin A1c level was 6.3 ± 1.3. Overall, 51 (61%) and 33 (39%) patients underwent unplanned and planned dialysis, respectively. On univariate analysis, the presence of IHD, peripheral vascular disease, ≥3 comorbidities, and unplanned initiation of dialysis were significantly related to death. On multivariate analysis, unplanned start of dialysis, ischemic heart diseases and peripheral vascular disease remained significant. Survival rates at 3 and 12 months were 38.6% vs. 90.9% and 14.4% vs. 73.6% for unplanned vs. planned dialysis, respectively (p < 0.001). Unplanned dialysis was significantly associated with greater mortality.
In elderly dialysis patients, unplanned start of dialysis was associated with poor survival. Patient characteristics such as associated peripheral vascular disease and IHD were associated with poor survival.
接受长期透析的老年患者数量日益增加。然而，透析在生存和生活质量方面的作用尚不清楚，不良结局可能与合并症有关，而不仅仅与年龄有关。据报道，老年慢性肾脏病（CKD）患者开始非计划性透析与生存不良有关。我们评估了与生存不良相关的患者因素和医疗实践因素。
我们对2010年10月至2014年2月期间在我们肾脏科开始长期透析的90例连续老年患者（≥75岁）进行了回顾性分析。排除6例患者；分析了其余84例（≥75岁）接受计划性或非计划性透析的终末期肾病患者的数据。对患者进行随访直至死亡或2015年1月。分析了患者因素，如开始透析时的年龄和合并症（即糖尿病、缺血性心脏病[IHD]、外周血管疾病、癌症、慢性阻塞性肺疾病和认知功能障碍）。比较了透析开始是计划性还是非计划性等医疗实践因素与生存结局的关系。“非计划性透析”定义为在透析开始前3个月内未由肾脏科医生评估的已知CKD 4期或5期患者。
开始透析时的平均年龄为81.5±4.5岁，血清白蛋白水平为24.8±6g/L，体重指数为22.5±4.8kg/m²，糖化血红蛋白A1c水平为6.3±1.3。总体而言，分别有51例（61%）和33例（39%）患者接受了非计划性和计划性透析。单因素分析显示，IHD、外周血管疾病、≥3种合并症以及非计划性开始透析与死亡显著相关。多因素分析显示，非计划性开始透析、缺血性心脏病和外周血管疾病仍然具有显著性。非计划性透析与计划性透析的3个月和12个月生存率分别为38.6%对90.9%和14.4%对73.6%（p<0.001）。非计划性透析与更高的死亡率显著相关。
在老年透析患者中，非计划性开始透析与生存不良有关。外周血管疾病和IHD等患者特征与生存不良有关。
