Ismail N, Hakim R M, Oreopoulos D G, Patrikarea A
Vanderbilt University School of Medicine, Nashville, TN.
Am J Kidney Dis. 1993 Dec;22(6):759-82. doi: 10.1016/s0272-6386(12)70334-7.
Recent demographic data from the United States and Europe demonstrate that the dialysis population is growing progressively older. In the United States the median age at onset of end-stage renal disease (ESRD) had reached 61 years in 1990, and the fraction of ESRD patients older than 65 years will approach 60% by the year 2000. The primary treatment of geriatric ESRD is center hemodialysis (82% of elderly patients). Chronic peritoneal dialysis in this age group is limited in the United States to less than 10%. Only 2.7% of elderly patients have a functioning transplant. Despite their complex medical and psychosocial conditions, survival and rehabilitation are acceptable in the elderly dialysis patient and these patients tend to be more complaint. Five-year dialysis patient survival rates in the United States are 19% and 10%, respectively, for the 65 to 74 and 75 to 84 age groups compared with 32% and 19%, respectively, for the same age groups in Europe. Five-year survival, particularly in the elderly, is even higher in Japan. Several factors favor the delivery of low doses of hemodialysis in the elderly and discontinuing dialysis is more common in the elderly. Continuous ambulatory peritoneal dialysis is a satisfactory alternative treatment modality for geriatric ESRD. Most studies confirm that survival of elderly patients on continuous ambulatory peritoneal dialysis and hemodialysis is similar. The 1991 United States Renal Data System report showing higher mortality among diabetic continuous ambulatory peritoneal dialysis patients than among hemodialysis patients may reflect selection of such patients, who may have more co-morbid conditions. In special cases, continuous cyclic peritoneal dialysis can be an alternative treatment for elderly ESRD patients.
美国和欧洲最近的人口统计数据表明，透析人群的年龄在逐渐增大。在美国，1990年终末期肾病（ESRD）发病的中位年龄已达61岁，到2000年，65岁以上的ESRD患者比例将接近60%。老年ESRD的主要治疗方式是中心血液透析（82%的老年患者）。在美国，这个年龄组的慢性腹膜透析比例不到10%。只有2.7%的老年患者有功能正常的移植肾。尽管老年透析患者存在复杂的医学和心理社会状况，但他们的生存和康复情况尚可，而且这些患者往往更配合。在美国，65至74岁和75至84岁年龄组透析患者的五年生存率分别为19%和10%，而欧洲同年龄组的五年生存率分别为32%和19%。在日本，五年生存率，尤其是老年患者的五年生存率更高。有几个因素有利于对老年人进行低剂量血液透析，而且在老年人中停止透析的情况更为常见。持续性非卧床腹膜透析是老年ESRD患者一种令人满意的替代治疗方式。大多数研究证实，老年患者接受持续性非卧床腹膜透析和血液透析的生存率相似。1991年美国肾脏数据系统的报告显示，糖尿病持续性非卧床腹膜透析患者的死亡率高于血液透析患者，这可能反映了这类患者的选择情况，他们可能有更多的合并症。在特殊情况下，间歇性腹膜透析可以作为老年ESRD患者的替代治疗方法。
