Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Faculty of Pharmacy, Pharmacoepidemiology and Statistics Research Center, Chiang Mai University, Chiang Mai, Thailand.
Ren Fail. 2024 Dec;46(2):2396448. doi: 10.1080/0886022X.2024.2396448. Epub 2024 Aug 30.
Initiating dialysis therapy in elderly patients with end-stage kidney disease (ESKD) is a challenging decision. We aimed to examine the mortality rates among elderly patients who underwent hemodialysis, peritoneal dialysis, or comprehensive conservative care. This retrospective cohort study included elderly patients (≥70 years) with ESKD who selected their treatment options from January 2008 to December 2018. Patients were categorized into three groups: hemodialysis, peritoneal dialysis, and comprehensive conservative care. The outcome of interest was all-cause mortality analyzed using flexible parametric survival models. Propensity score analysis with inverse probability treatment weighting technique was performed, incorporating age, Charlson Comorbidity Index score, and estimated glomerular filtration rate. The study included 719 elderly ESKD patients with mean age of 78.2 ± 4.9 years, 52.3% were male, and 60.1% died during the median follow-up period of 22.1 months. In a fully adjusted model, patients receiving comprehensive conservative care ( = 50) had higher mortality rates than those receiving hemodialysis ( = 317) (adjusted hazard ratio [HR] 5.60; 95% CI 2.26-13.84, < 0.001). However, patients who received peritoneal dialysis ( = 352) had a similar mortality rate when compared to those who received hemodialysis (adjusted HR 1.38; 95% CI 0.78-2.44, = 0.275). The higher mortality rate in the comprehensive conservative care group remained significantly higher than in the hemodialysis group among patients aged ≥80 years (adjusted HR 4.97; 95% CI 1.32-18.80, = 0.018). Among elderly patients (≥70 years), treatment with dialysis was associated with longer survival rates. This survival advantage persisted in patients aged ≥80 years who chose hemodialysis or peritoneal dialysis over comprehensive conservative care.
在老年终末期肾病（ESKD）患者中开始透析治疗是一个具有挑战性的决策。我们旨在研究接受血液透析、腹膜透析或综合保守治疗的老年患者的死亡率。这项回顾性队列研究纳入了 2008 年 1 月至 2018 年 12 月期间选择治疗方案的老年（≥70 岁）ESKD 患者。患者分为三组：血液透析、腹膜透析和综合保守治疗。主要结局为全因死亡率，采用灵活参数生存模型进行分析。采用逆概率治疗加权技术进行倾向评分分析，纳入年龄、Charlson 合并症指数评分和估计肾小球滤过率。研究纳入了 719 名平均年龄为 78.2±4.9 岁的老年 ESKD 患者，其中 52.3%为男性，中位随访 22.1 个月期间 60.1%的患者死亡。在完全调整模型中，接受综合保守治疗的患者（n=50）死亡率高于接受血液透析的患者（n=317）（调整后的危险比[HR]5.60；95%CI 2.26-13.84， < 0.001）。然而，与接受血液透析的患者相比，接受腹膜透析的患者（n=352）的死亡率相似（调整后的 HR 1.38；95%CI 0.78-2.44， = 0.275）。在≥80 岁的患者中，综合保守治疗组的死亡率仍然明显高于血液透析组（调整后的 HR 4.97；95%CI 1.32-18.80， = 0.018）。在老年（≥70 岁）患者中，透析治疗与生存率的提高相关。这种生存优势在选择血液透析或腹膜透析而非综合保守治疗的≥80 岁患者中仍然存在。
