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老年維持性血液透析患者臨床特徵橫斷面研究
A cross-sectional study on the characteristics of the elderly patients on Maintenance hemodialysis
摘要
目的：通過對老年維持性血液透析（Maintenance Hemodialysis, MHD）患者的臨床資料進行橫斷面研究，總結老年MHD患者的臨床特徵，探討老年MHD治療策略。方法：截止2020年12月31日在鏡湖醫院血透中心治療的MHD患者，分為老年組（年齡≥65歲）和非老年組（年齡<65歲），比較兩組在一般資料（年齡，性別，原發疾病、透析模式、透析齡、血管通路類型）、實驗室指標（血色素、轉鐵蛋白飽和度、鐵蛋白、鈣、磷、尿素）以及透析充分性指標（尿素氮清除率，單室尿素清除率）等方面的差異。結果：共512名患者納入研究，老年組322人（62.9%），非老年組190人（37.1%）。與非老年組相比，老年組中女性比例較高（43.8% VS 31.1%, P =0.004），平均體重低（57.61±12.95kg VS 61.45±12.82kg, P =0.001），原發病腎小球疾病比例降低（18.3% VS 26.3%,P =0.033）；高通透析比例低（75.5% VS 86.8%, P =0.002）；血管通路中動靜脈內瘺使用率偏低，長期導管使用率相對較高（P分別為0.000和0.001）。兩組的血色素、鈣水平比較無統計學差異（P >0.05），老年組轉鐵蛋白飽和度、鐵蛋白和磷均明顯高於非老年組（P <0.05），而白蛋白，透前、透後尿素水平均明顯低於非老年組（P <0.05）。兩組在透析充分性指標URR和spKT/V的比較沒有統計學差異（P >0.05）。結論：老年MHD患者人數多，年齡大，合併糖尿病比例高，血管條件差，營養狀態欠佳。重視老年患者綜合狀態評估，選擇合適的血管通路和治療模式，積極糾正貧血和營養不良，有利於降低死亡風險。
並列摘要
Objective: This cross-sectional study aimed to investigate the clinical characteristics of elderly patients on maintenance hemodialysis (MHD) and to try to improve management skills. Methods: Patients who underwent MHD at Kiang Wu Hospital at the end of 2020.12.31 were enrolled and divided into elderly (age≥ 65 years) and nonelderly groups (<65 years) according to age. Data including patients' general information (age, sex, primary disease, dialysis modality, dialysis age, blood access), laboratory examinations (hemoglobin, transferrin saturation, ferritin, calcium, phosphate, urea) and dialysis adequacy index were collected and compared. Results: Finally, 512 patients were enrolled, while 322 patients (62.9%) were in the elderly group and 190 patients (37.1%) were in the nonelderly group. Compared to the nonelderly group, the elderly group obviously had a higher female ratio (43.8% vs 31.1%, P =0.004), lower average weight (57.61±12.95kg vs 61.45±12.82kg, P =0.001), lower glomerular disease percentage (18.3% vs 26.3%, P =0.033) among primary diseases, lower proportion in high flux dialysis (75.5% vs 86.8%, P=0.002), less AVF and more permanent catheter usage in blood access. There was no significant difference between the two groups in terms of the hemoglobin and calcium levels (P >0.05). The serum transferrin saturation (TSAT), ferritin and phosphate levels of the elderly group were significantly higher. In contrast, albumin and urea levels before and after dialysis were significantly lower than those of the nonelderly group. Conclusion: The population of elderly MHD patients is getting increasingly older from diabetic complications with poor vascular and nutritional conditions. More efforts should be put on comprehensive evaluations for elderly MHD patients to assist in choosing proper blood access and dialysis modality. Timely correction of anemia and malnutrition might lower the risk of mortality.