Department of Internal Medicine, National Police Hospital, Seoul, Republic of Korea.
Department of Internal Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea.
Am J Nephrol. 2023;54(5-6):175-183. doi: 10.1159/000530933. Epub 2023 May 18.
The number of elderly patients with end-stage renal disease (ESRD) is increasing worldwide. However, decision-making about elderly patients with ESRD remains complex because of the lack of studies, especially in very elderly patients (≥75 years). We examined the characteristics of very elderly patients starting hemodialysis (HD) and the associated mortality and prognostic factors.
Data were analyzed retrospectively using a nationwide cohort registry, the Korean Renal Data System. Patients who started HD between January 2016 and December 2020 were included and divided into three groups according to age at HD initiation (<65, 65-74, and ≥75 years). The primary outcome was all-cause mortality during the study period. Risk factors for mortality were analyzed using Cox proportional hazard models.
In total, 22,024 incident patients were included with 10,006, 5,668, and 6,350 in each group (<65, 65-74, and ≥75 years, respectively). Among the very elderly group, women had a higher cumulative survival rate than men. The survival rate was lower in patients with vascular access via a catheter than in those with an arteriovenous fistula or graft. Very elderly patients with more comorbid diseases had a significantly lower survival rate than those with fewer comorbidities. In the multivariate Cox models, old age, cancer presence, catheter use, low body mass index, low Kt/V, low albumin concentration, and capable status of partial self-care were associated with high risk of mortality.
Preparation of an arteriovenous fistula or graft when starting HD should be considered in very elderly patients with fewer comorbid diseases.
全球范围内，终末期肾病（ESRD）老年患者人数不断增加。然而，由于缺乏研究，尤其是针对非常高龄患者（≥75 岁）的研究，老年 ESRD 患者的决策仍然很复杂。我们研究了开始血液透析（HD）的非常高龄患者的特征及其与死亡率的关系和预后因素。
我们使用全国性队列登记系统——韩国肾脏数据系统，对 2016 年 1 月至 2020 年 12 月期间开始 HD 的患者进行回顾性数据分析。将纳入的患者按 HD 开始时的年龄（<65 岁、65-74 岁和≥75 岁）分为三组。主要结局为研究期间的全因死亡率。采用 Cox 比例风险模型分析死亡风险因素。
共纳入 22024 例首发患者，每组各 10006、5668 和 6350 例（<65 岁、65-74 岁和≥75 岁）。在高龄组中，女性的累积生存率高于男性。与动静脉瘘或移植物相比，通过导管建立血管通路的患者生存率较低。合并症较多的高龄患者的生存率显著低于合并症较少的患者。多变量 Cox 模型显示，高龄、癌症、导管使用、低体重指数、低 Kt/V、低白蛋白浓度和部分自理能力与高死亡率风险相关。
对于合并症较少的非常高龄患者，在开始 HD 时应考虑准备动静脉瘘或移植物。
