De Vecchi A F, Maccario M, Braga M, Scalamogna A, Castelnovo C, Ponticelli C
Division of Nephrology and Dialysis, IRCCS Ospedale Maggiore, Milan, Italy.
Am J Kidney Dis. 1998 Mar;31(3):479-90. doi: 10.1053/ajkd.1998.v31.pm9506685.
In all industrial countries, the number of elderly patients who need dialysis has increased in recent years. In the present study, we retrospectively analyzed two different age groups of nondiabetic peritoneal dialysis patients treated at the same unit by the same team of physicians and nurses with the same protocols. However, our purpose was to study possible differences in technique and survival rates, causes of dropout, complications, hospitalization rate, and everyday needs between the two groups. The results of 63 consecutive nondiabetic patients older than 70 years treated with continuous ambulatory peritoneal dialysis (CAPD) were compared with those of 86 nondiabetic patients aged 40 to 60 years treated during the same period. Patient survival was significantly worse in the elderly patients, but the observed to expected survival ratio with respect to age was similar. Technique survival was comparable in the two groups. Total hospitalization was 5,501 days (32 d/yr) in the elderly patients and 4,511 days (18 d/yr; P < 0.05) in the younger group. The peritonitis rate was 0.52 episodes/patient-year in the elderly patients and 0.37 episodes/patient-year in the younger patients (P < 0.002). The exit site infection rate was similar in the two groups (0.30 episodes/yr v0.29 episodes/yr). Other complications related to CAPD did not differ between the elderly and younger patients. Rehabilitation and biochemical data after 1 year of CAPD were similar in the two groups of patients. After 1 year of treatment, 12% of the younger patients and 43% of the elderly patients (P < 0.005) needed a partner for dialysis. Twenty-nine of 39 (74%) of the elderly patients and 30 of 53 (57%) of the younger patients considered their lifestyle acceptable after 1 year of dialysis. Thirty-four of 39 (87%) of the elderly patients and 32 of 53 (60%) of the younger patients (P < 0.02) rated their physical and social state after rehabilitation as better or comparable to that they had before terminal uremia.
在所有工业化国家，近年来需要透析的老年患者数量有所增加。在本研究中，我们回顾性分析了同一单位由同一医生和护士团队按照相同方案治疗的两个不同年龄组的非糖尿病腹膜透析患者。然而，我们的目的是研究两组在技术和生存率、退出治疗的原因、并发症、住院率以及日常需求方面可能存在的差异。将63例年龄大于70岁接受持续性非卧床腹膜透析（CAPD）治疗的连续非糖尿病患者的结果与同期治疗的86例年龄在40至60岁的非糖尿病患者的结果进行比较。老年患者的患者生存率明显较差，但相对于年龄的观察到的预期生存率相似。两组的技术生存率相当。老年患者的总住院天数为5501天（32天/年），年轻组为4511天（18天/年；P<0.05）。老年患者的腹膜炎发生率为0.52次/患者年，年轻患者为0.37次/患者年（P<0.002）。两组的出口部位感染率相似（0.30次/年对0.29次/年）。与CAPD相关的其他并发症在老年和年轻患者之间没有差异。两组患者在CAPD治疗1年后的康复和生化数据相似。治疗1年后，12%的年轻患者和43%的老年患者（P<0.005）需要他人协助进行透析。39例老年患者中有29例（74%），53例年轻患者中有30例（57%）在透析1年后认为他们的生活方式可以接受。39例老年患者中有34例（87%），53例年轻患者中有32例（60%）（P<0.02）将康复后的身体和社会状态评为优于或等同于终末期尿毒症前的状态。
