Renal Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Renal Unit, Lister Hospital, Stevenage, Hertfordshire, UK.
Nephrol Dial Transplant. 2018 May 1;33(5):742-750. doi: 10.1093/ndt/gfy042.
Current guidelines for dialysis specify a minimum Kt/V. For haemodialysis (HD) patients, minimum treatment time and frequency is also specified. The guidelines allow for modification to take account of renal function. The guidelines are not specifically aimed at the elderly and may not be appropriate for all patients in this group. Increasing age is accompanied by physiological and pathological changes that may modify the patient's response to uraemia and dialysis. Frailty and multi-morbidity are likely, but to a variable extent. Elderly patients could be more susceptible to the effects of uraemia and require a higher dose of dialysis. Conversely, the generation rate of uraemic toxins is lower in elderly patients, potentially reducing the need for dialysis. In the elderly, quality of life may be more adversely affected by multimorbidity than uraemic symptoms, thus the dose of dialysis may be less relevant. Higher doses of dialysis may be more difficult to achieve in the elderly and may be less well tolerated. We conclude that the prescription of dialysis in the elderly should be individualized, taking multiple factors into account. An individualized Kt/V may be useful in controlling dialysis dose and detecting problems in delivery. However, achievement of a specified Kt/V may not result in any benefit to an elderly patient and could be counterproductive.
目前的透析指南规定了最小 Kt/V 值。对于血液透析 (HD) 患者，也规定了最低治疗时间和频率。指南允许进行调整以考虑肾功能。该指南并非专门针对老年人制定，可能并不适用于该组中的所有患者。随着年龄的增长，会出现生理和病理变化，这可能会改变患者对尿毒症和透析的反应。虚弱和多病共存很可能发生，但程度不同。老年患者可能更容易受到尿毒症的影响，需要更高剂量的透析。相反，老年患者尿毒症毒素的产生率较低，可能减少透析的需求。在老年人中，多病共存对生活质量的影响可能比尿毒症症状更严重，因此透析剂量可能不太重要。在老年人中，可能更难以达到更高剂量的透析，并且可能耐受性较差。我们得出结论，老年患者的透析处方应个体化，考虑多种因素。个体化 Kt/V 可能有助于控制透析剂量并检测输送中的问题。然而，达到特定的 Kt/V 值可能不会使老年患者受益，反而可能适得其反。
