Kim Hyunglae, Jeong Seon A, Kim Kyeong Min, Hwang Sun Deuk, Choi Sun Ryoung, Lee Hajeong, Kim Ji Hyun, Kim Su Hyun, Kim Tae Hee, Koo Ho-Seok, Yoon Chang-Yun, Kim Kiwon, Ahn Seon Ho, Yoon Hye Eun, Kim Yong Kyun, Ban Tae Hyun, Hong Yu Ah
Department of Internal Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
The Korean Society of Nephrology, Seoul, Republic of Korea.
Kidney Res Clin Pract. 2024 May;43(3):263-273. doi: 10.23876/j.krcp.23.267. Epub 2024 May 28.
With an increasing aging population, the mean age of patients with end-stage kidney disease (ESKD) is globally increasing. However, the current clinical status of elderly patients undergoing hemodialysis (HD) is rarely reported in Korea. The current study analyzed the clinical features and trends of older patients undergoing HD from the Korean Renal Data System (KORDS) database. The patients were divided into three groups according to age: <65 years (the young group), n = 50,591 (35.9%); 65-74 years (the younger-old group), n = 37,525 (26.6%); and ≥75 years (the older-old group), n = 52,856 (37.5%). The proportion of older-old group undergoing HD significantly increased in incidence and decreased in prevalence from 2013 to 2022. The median levels of hemoglobin, serum creatinine, albumin, calcium, phosphorus, and intact parathyroid hormone significantly decreased in the older-old group. The proportions of arteriovenous fistula creation and left forearm placement showed decreased trends with age. Although the utilization of low surface area dialyzers increased with age, the dialysis adequacy, including urea reduction ratio and Kt/V was within acceptable range in the older-old group on HD. Over the past 20 years, the mortality rate in the older-old group has increased, with cardiovascular diseases decreasing and infectious diseases increasing. The incidence of elderly patients undergoing HD has increased over time, but the high mortality of the older-old group needs to be solved. Therefore, it is imperative to develop holistic strategies based on age and individual needs for patients with ESKD.
随着人口老龄化加剧，全球终末期肾病（ESKD）患者的平均年龄在不断增加。然而，韩国很少有关于接受血液透析（HD）的老年患者的当前临床状况的报道。本研究分析了来自韩国肾脏数据系统（KORDS）数据库的接受HD的老年患者的临床特征和趋势。根据年龄将患者分为三组：<65岁（年轻组），n = 50,591（35.9%）；65 - 74岁（较年轻老年组），n = 37,525（26.6%）；≥75岁（老年组），n = 52,856（37.5%）。从2013年到2022年，老年组接受HD的发病率显著增加，患病率下降。老年组血红蛋白、血清肌酐、白蛋白、钙、磷和完整甲状旁腺激素的中位数水平显著下降。动静脉内瘘创建和左前臂放置的比例随年龄呈下降趋势。尽管低表面积透析器的使用率随年龄增加，但老年组HD患者的透析充分性，包括尿素清除率和Kt/V仍在可接受范围内。在过去20年中，老年组的死亡率有所上升，心血管疾病导致的死亡减少，传染病导致的死亡增加。接受HD的老年患者的发病率随时间增加，但老年组的高死亡率问题有待解决。因此，为ESKD患者制定基于年龄和个体需求的整体策略势在必行。
