Baek M Y, Kwon T H, Kim Y L, Cho D K
Department of Internal Medicine, Kyungpook University Hospital, Taegu, Korea.
Adv Perit Dial. 1997;13:158-61.
Rapid growth in the number of dialysis patients over the age of 65 is occurring coincidentally with the overall aging of the general population. Elderly patients are often poor and physically incapacitated, needing family or social support. These patients may also be susceptible to malnutrition and have multiple complicating medical disorders in addition to end-stage renal disease (ESRD). Thus the selection of an appropriate dialysis modality is particularly critical in elderly patients. Continuous ambulatory peritoneal dialysis (CAPD) offers many advantages to elderly patients, including hemodynamic stability, steady-state chemistries, and no need to create a vascular access. However, little data are available in the literature documenting the use of CAPD in this setting. Therefore, to evaluate the efficacy of CAPD in elderly patients, we retrospectively reviewed the clinical outcomes of 23 patients 65 years of age or older at the start of CAPD (elderly group). Then for each of these patients, 23 comparison subjects younger than 65 were chosen from CAPD patients at our hospital (control group). The control group was matched for sex, CAPD duration, cause of ESRD, and initial connection device. In the elderly group, 23 patients (12 male, 11 female) with a mean age of 70 +/- 4 years (range 65-86 years) were treated with CAPD for 15 +/- 17 months. In the control group, 23 patients (12 male, 11 female) with a mean age of 41 +/- 11 (range 18-57) were treated with CAPD for 16 +/- 17 months. Diabetic nephropathy was the cause of ESRD in 35% of patients. The negative CAPD selection of patients was higher in the elderly group (61% vs 17%, p = 0.0025) as well as in the group that needed a helper (61% vs 17%, p = 0.0025). The exit-site infection and peritonitis rates were not statistically different between the two groups (0.43 vs 0.91 episodes/patient-year and 1.46 vs 2.03 episodes/patient-year). The dialysate leakage and bleeding rates were comparable (13% vs 22% and 9% vs 9%). One-year catheter survival was similar in the elderly and younger patients (87.5% vs 84.0%). Although the negative CAPD selection of patients was higher in the elderly group, outcomes were similar to those seen in younger patients. Therefore, CAPD is an acceptable form of therapy for the elderly ESRD patients, particularly if a helper can participate.
65岁及以上透析患者数量的快速增长与普通人群的整体老龄化同时出现。老年患者往往贫困且身体残疾，需要家庭或社会支持。这些患者除了患有终末期肾病（ESRD）外，还可能易患营养不良并有多种复杂的内科疾病。因此，选择合适的透析方式对老年患者尤为关键。持续性非卧床腹膜透析（CAPD）对老年患者有许多优点，包括血流动力学稳定、稳态化学指标以及无需建立血管通路。然而，文献中几乎没有关于在这种情况下使用CAPD的数据。因此，为了评估CAPD在老年患者中的疗效，我们回顾性分析了23例开始进行CAPD时年龄在65岁及以上的患者（老年组）的临床结局。然后，从我院的CAPD患者中为这些患者每人选取23例年龄小于65岁的对照对象（对照组）。对照组在性别、CAPD持续时间、ESRD病因和初始连接装置方面进行了匹配。老年组中，23例患者（12例男性，11例女性），平均年龄70±4岁（范围为65 - 86岁），接受CAPD治疗15±17个月。对照组中，23例患者（12例男性，11例女性），平均年龄41±11岁（范围为18 - 57岁），接受CAPD治疗16±17个月。35%的患者ESRD病因是糖尿病肾病。老年组患者CAPD治疗终止率较高（61%对17%，p = 0.0025），需要协助者的组中也是如此（61%对17%，p = 0.0025）。两组的出口部位感染率和腹膜炎发生率无统计学差异（分别为0.43对0.91次/患者年和1.46对2.03次/患者年）。透析液渗漏率和出血率相当（分别为13%对22%和9%对9%）。老年患者和年轻患者的导管1年生存率相似（87.5%对84.0%）。尽管老年组患者CAPD治疗终止率较高，但结局与年轻患者相似。因此，CAPD是老年ESRD患者可接受的治疗方式，特别是如果有协助者参与的话。
