Harris S A, Brown E A
Department of Renal Medicine, Charing Cross Hospital, London, UK.
Nephrol Dial Transplant. 1998 May;13(5):1226-33. doi: 10.1093/ndt/13.5.1226.
The purpose of this survey was to describe the natural history of complications in 52 long-surviving haemodialysis patients to obtain a clearer picture of the impact these patients have on the dialysis population. This is important as they are often no longer suitable for transplantation and therefore are destined to remain on dialysis for the rest of their lives.
The patients who survived for more than 10 years on haemodialysis alone were studied. Information was obtained from patients' records and from the renal unit computer.
Mean age at start of dialysis was 43 years and mean duration of HD 14.5 years. Renal failure was most commonly due to polycystic kidney disease or glomerulonephritis. Sixty-two per cent of patients developed cardiovascular disease, 78% complained of joint pains, 72% had a parathyroidectomy, and 50% developed carpal-tunnel syndrome. Two hundred and forty-five episodes of infection were recorded, 41% related to vascular access acquired in hospital or on immunosuppression. Only three infections occurred which could be described as opportunistic. Twelve patients were hepatitis C positive. In the 37 patients who have died, cardiovascular disease was the most common cause of death. Compared to other patients who started on dialysis before 1986 but who had a successful transplant the survival of patients on haemodialysis is much worse.
Long-term survival on renal replacement therapy is dependent on successful transplantation. Complications, morbidity, and mortality are high after 10 years of dialysis.
本次调查旨在描述52例长期存活的血液透析患者并发症的自然史，以便更清楚地了解这些患者对透析人群的影响。这一点很重要，因为他们往往不再适合移植，因此注定要在透析中度过余生。
对仅接受血液透析超过10年的患者进行研究。信息来自患者记录和肾脏科电脑。
开始透析时的平均年龄为43岁，血液透析平均时长为14.5年。肾衰竭最常见的原因是多囊肾病或肾小球肾炎。62%的患者患心血管疾病，78%的患者抱怨关节疼痛，72%的患者接受了甲状旁腺切除术，50%的患者出现腕管综合征。记录到245次感染发作，41%与在医院获得的血管通路或免疫抑制有关。只有3次感染可被描述为机会性感染。12名患者丙型肝炎呈阳性。在已死亡的37名患者中，心血管疾病是最常见的死亡原因。与1986年之前开始透析但移植成功的其他患者相比，血液透析患者的存活率要低得多。
肾脏替代治疗的长期存活取决于成功的移植。透析10年后并发症、发病率和死亡率都很高。
