Helve Jaakko, Kramer Anneke, Abad Diez Jose Maria, Aresté-Fosalba Nuria, Arici Mustafa, Cases Aleix, Collart Frederic, Heaf James, De Meester Johan, Nordio Maurizio, Palsson Runolfur, Pobes Alfonso, Rydell Helena, Reisæter Anna Varberg, Massy Ziad A, Jager Kitty J, Finne Patrik
Finnish Registry for Kidney Diseases, Helsinki, Finland.
Abdominal Center Nephrology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Nephrol Dial Transplant. 2021 Mar 29;36(4):688-694. doi: 10.1093/ndt/gfaa278.
The number of elderly patients on renal replacement therapy (RRT) is increasing. The survival and quality of life of these patients may be lower if they have multiple comorbidities at the onset of RRT. The aim of this study was to explore whether the effect of comorbidities on survival is similar in elderly RRT patients compared with younger ones.
Included were 9333 patients ≥80 years of age and 48 352 patients 20-79 years of age starting RRT between 2010 and 2015 from 15 national or regional registries submitting data to the European Renal Association-European Dialysis and Transplantation Association Registry. Patients were followed until death or the end of 2016. Survival was assessed by Kaplan-Meier curves and the relative risk of death associated with comorbidities was assessed by Cox regression analysis.
Patients ≥80 years of age had a greater comorbidity burden than younger patients. However, relative risks of death associated with all studied comorbidities (diabetes, ischaemic heart disease, chronic heart failure, cerebrovascular disease, peripheral vascular disease and malignancy) were significantly lower in elderly patients compared with younger patients. Also, the increase in absolute mortality rates associated with an increasing number of comorbidities was smaller in elderly patients.
Comorbidities are common in elderly patients who enter RRT, but the risk of death associated with comorbidities is less than in younger patients. This should be taken into account when assessing the prognosis of elderly RRT patients.
接受肾脏替代治疗（RRT）的老年患者数量正在增加。如果这些患者在开始RRT时患有多种合并症，其生存和生活质量可能会更低。本研究的目的是探讨与年轻患者相比，合并症对老年RRT患者生存的影响是否相似。
纳入了9333例年龄≥80岁的患者和48352例年龄在20 - 79岁之间的患者，这些患者于2010年至2015年期间开始接受RRT，数据来自向欧洲肾脏协会 - 欧洲透析和移植协会登记处提交数据的15个国家或地区登记处。对患者进行随访直至死亡或2016年底。通过Kaplan-Meier曲线评估生存情况，并通过Cox回归分析评估与合并症相关的死亡相对风险。
年龄≥80岁的患者合并症负担比年轻患者更重。然而，与所有研究的合并症（糖尿病、缺血性心脏病、慢性心力衰竭、脑血管疾病、外周血管疾病和恶性肿瘤）相关的死亡相对风险在老年患者中显著低于年轻患者。此外，老年患者中与合并症数量增加相关的绝对死亡率增幅较小。
进入RRT的老年患者合并症很常见，但与合并症相关的死亡风险低于年轻患者。在评估老年RRT患者的预后时应考虑到这一点。
