老年维持性血液透析患者生存分析

摘要

目的 分析老年维持性血液透析患者的生存情况,探讨影响老年维持性血液透析患者生存的主要危险因素.方法 对2005年1月1日～2009年12月31日新进入维持性血液透析且年龄≥60岁的终末期肾病患者进行回顾性研究,随访至2010年12月31日.应用Kaplan-Meier法、Cox回归模型分析患者的生存资料.结果 共131例血液透析患者,中位随访时间为25(14～41)月,死亡52例,中位生存期48(37.72～58.28)月.主要死因为充血性心力衰竭、感染、脑血管疾病.死亡患者的透始年龄、透析前合并脑血管疾病比例、合并充血性心力衰竭比例、Charison 合并症指数(Charlson comorbidity index,CCI)≥5比例、首次透析血管通路为临时导管比例、透析原因为心力衰竭比例、透始eGFR均显著高于非死亡患者,而CCI=3～4比例、透始尿量、血肌酐、血白蛋白均显著低于非死亡患者.Kaplan-Meier生存曲线显示老年维持性血液透析患者1年、2年、3年、4年、5年生存率分别为80.9％、74.6％、63.2％、48.0％、33.9％.Cox回归分析显示透始年龄(HR=1.070, 95％CI 1.015～1.127,P＜0.05)、透析前合并脑血管疾病(HR=2.052,95％CI 1.035～4.068,P＜0.05)、合并充血性心力衰竭(HR=1.888,95％CI 1.029～3.463,P＜0.05)、CCI≥5(HR=2.675,95％CI 1.323～5.411,P＜0.05)、透始血白蛋白(HR=0.949,95％CI 0.901～0.999,P＜0.05)是影响老年维持性血液透析患者生存的主要危险因素.结论 老年维持性血液透析患者的主要死因为心血管疾病、感染、脑血管疾病.透始年龄、营养状况、合并疾病状况可能是影响老年维持性血液透析患者生存的主要危险因素.%Objective To perform survival analysis and to explore the main risk factors affecting survival in elderly patients on maintenance hemodialysis (MHD). Methods Incident patients with end stage of renal disease starting hemodialysis between 1 January 2005 and 31 December 2009 and followed up through 31 December 2010 were enrolled in this retrospective cohort study. Survival analysis was performed using Kaplan-Meier method and Cox regression model. Results A total of 131 patients were included in this study. The median follow-up period was 25 months (14-41 months) from initiation of dialysis, and 52 patients died in the follow-up period. The median survival time was 48 months (37.72-58.28 months). The main causes of death were congestive heart failure, infection and cerebrovascular disease. In the death cases, the age when dialysis began was older. More patients were found to have congestive heart failure and cerebrovascular disease history before dialysis, Charlson co-morbidity index (CCI) ≥ 5, catheters for hemodialysis vascular access, and dialysis due to heart failure. The estimated glomerular filtration rate (eGFR) at the initiation of dialysis increased significantly. The proportion of patients with CCI=3-4 was lower. In addition, urine volume, serum creatinine and serum albumin at initiation of dialysis were significantly lower than the survival cases. Kaplan-Meier survival curve revealed that the 1 year, 2year, 3year, 4year and 5year survival rate of elderly MHD patients was 80.9%, 74.6%, 63.2%, 48.0% and 33.9%, respectively. Cox regression model indicated that older age (HR=1.070, 95% CI 1.015-1.127, P<0.05), history of cerebrovascular accident before dialysis (HR=2.052, 95% CI 1.035-4.068, P<0.05), history of congestive heart failure before dialysis (HR=1.888, 95% CI 1.029 -3.463, P<0.05), CCI =5 before dialysis (HR=2.675, 95% CI 1.323-5.411, P<0.05) and lower serum albumin at initiation of dialysis (HR=0.949, 95% CI 0.901 -0.999, P<0.05) were the main risk factors for survival of elderly MHD patients. Conclusions The main causes of death in elderly MHD patients were cardiovascular disease, infection and cerebrovascular disease. Older age, malnutrition status, and co-morbidities at initiation of dialysis may be the main risk factors for survival of elderly MHD patients.