Nissenson A R
Department of Medicine, UCLA School of Medicine.
Kidney Int Suppl. 1993 Feb;40:S51-7.
It is clear that an increasing number of elderly patients will require ESRD care as the decade proceeds. Currently available data suggest that outcomes on HD and CPD are similar in this patient group, although the data in elderly diabetics are not all in. A number of questions remain to be answered, however: (1) Can severity indices be developed so that patients can be properly matched for co-morbid conditions? This is essential if firm conclusions about the outcome of one modality compared to another can be drawn. (2) Is survival of elderly diabetics worse on CPD compared to HD? If so, is this because of differences in patient selection or co-morbidity or in the effects of the modality? (3) Can a simple, easy to use modality selection algorithm be developed for the elderly ESRD patient? (4) What factors add to the risk of morbidity and mortality in elderly ESRD patients, and how they can be modified? (5) What is the incidence of malnutrition in elderly ESRD patients? How does it relate to morbidity and mortality? Does it differ from those on HD compared to CPD? (6) Are there elderly patients who should not be started on dialysis? How can they be identified?
显然，随着时间的推移，越来越多的老年患者将需要接受终末期肾病（ESRD）护理。目前可得的数据表明，在这一患者群体中，血液透析（HD）和持续不卧床腹膜透析（CPD）的治疗效果相似，不过老年糖尿病患者的数据尚未全部得出。然而，仍有一些问题有待解答：（1）能否制定严重程度指数，以便患者能够根据合并症进行恰当匹配？如果要得出关于一种治疗方式与另一种治疗方式效果的可靠结论，这一点至关重要。（2）与血液透析相比，老年糖尿病患者接受持续不卧床腹膜透析时的生存率是否更低？如果是，这是因为患者选择、合并症的差异，还是治疗方式的影响？（3）能否为老年终末期肾病患者开发一种简单易用的治疗方式选择算法？（4）哪些因素会增加老年终末期肾病患者发病和死亡的风险，以及如何对这些因素进行调整？（5）老年终末期肾病患者营养不良的发生率是多少？它与发病和死亡有何关系？与接受血液透析的患者相比，接受持续不卧床腹膜透析的患者情况是否不同？（6）是否存在不应开始透析治疗的老年患者？如何识别他们？
