老年血液透析患者的临床特征分析

摘要

Objective To evaluate the clinical characteristics of elderly patients with end stage renal disease on maintenance hemodialysis. Methods Blood biochemistry tests, mortality rates and causes of death in the 167 elderly hemodialysis patients and 140 non-elderly hemodialysis patients were analyzed. Results Secondary kidney disease in elderly patients was higher than non-elderly hemodialysis patients. There were no significant differences in the serum calcium, parathyroid hormone, ferritin level, erythropoietin dosage and KT/V between the two groups. Compared with the non-elderly hemodialysis patients, serum albumin, blood urea nitrogen, serum creatinine, phosphate, diastotic blood pressure and weight gain were lower in elderly patients (P<0.01). Serum hsCRP level was higher in elderly patients (P<0.01). After 1 year, 16 elderly patients and 6 non-edlerly patients died. In elderly patients, the incidence of cerebral vascular accident, infection, tumor, myocardial infarction and hyperkalemia were 50 %, 31.2%, 6.3%, 6.3% and 6.3%, respectively. In non-elderly patients, the incidence of cerebral bleeding, infection, tumor, myocardial infarction and hyperkalemia were 33 %, 16.6 %, 16.6 %, 16.6 % and 16.6 %, respectively. Kidney transplantation was carried on 5 non-elderly patients and one patient was undergone peritoneal dialysis. Conclusions Along with the continuous advancing of hemodialysis technology, elderly dialysis patients have improved quality of dialysis and prolonged survival time. The primary causes of their death are cerebral vascular accident and infection.%目的 探讨老年维持性血液透析患者的临床特征.方法 选择1993年3月～2010年5月间在杭州市中医院肾内科进行维持性血液透析治疗的167例老年血液透析患者(≥60岁)和同期140例非老年维持性血液透析患者,对比分析两组的病闪、营养指标、透析效果、临床转归等.结果 继发性肾脏疾病在老年组发病率增加.两组患者间总胆同醇(TC)、甘油三酯(TG)、钙(Ca)、甲状旁腺激素(PTH)、铁蛋白(Fer)及每月促红索用量无统计学差异(P>0.05).老年组透析前血浆白蛋白(Alb)、尿素氮(BUN)、血清肌酐(Cr)、磷(P)、舒张压、透析间期增重均低于非老年组,hsCRP水平高于非老年组(P<0.01).两组间尿素氮清除效率(Kt/v)比无统计学差异.随访1年,老年组死亡16例,其中脑血管意外8例(50%),感染5例(31.2%),肿瘤1例(6.3%),心肌梗死1例(6.3%),高钾血症,1例(6.3%);非老年组死亡6例,其中脑出血2例(33%),感染1例(16.6%),肾癌1例(16.6%),心肌梗死1例(16.6%).高钾血症1例(16.6%).非老年组另有5例改行肾移植,1例改行腹透.结论 随着透析技术不断进步,老年透析患者透析质昔改善.生存期延长.脑血管并发症和感染是主要死亡原因.