Octogenarians and nonagenarians starting dialysis in the United States
Octogenarians and nonagenarians starting dialysis in the United States
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DOI：
10.7326/0003-4819-146-3-200702060-00006
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发表时间：
2007-02-06
影响因子：
39.2
通讯作者：
Chertow, Glenn M.
中科院分区：
文献类型：
--
作者：
Kurella, Manjula;Covinsky, Kenneth E.;Chertow, Glenn M.
背景资料：老年人构成了终末期肾病（ESRD）人群中增长最快的部分，但在非常老年人中，即80岁及以上的老年人，透析的流行病学和结果以前没有在全国范围内进行过研究。目的：描述最近开始透析的老年人和90岁以上老年人的发病率和结果趋势。设计：观察性研究。设置：美国肾脏数据系统，一个综合性的国家ESRD患者登记系统。参与者：1996年至2003年期间开始透析的老年人和90岁以上老年人。测量：透析开始率和生存率。结果：开始透析的老年人和九十岁以上的人从1996年的7 054人增加到2003年的13 577人，相当于透析开始的平均年增长率为9.8%。考虑到人口增长因素后，1996年至2003年期间透析开始率增加了57%（率比，1.57 [95%CI，1.53 - 1.62]）。老年人和90岁以上的人开始透析后的一年死亡率为46%。与1996年开始透析的老年人和90岁以上的人相比，2003年开始透析的人肾小球滤过率更高，慢性肾脏疾病相关的发病率更低，但1年生存率无差异。与死亡密切相关的临床特征是年龄较大，卧床状态，和更多的共病conditions.Limitations：生存的事件终末期肾病患者谁没有开始透析不能被assessed.Conclusions：在过去的十年中，开始透析的老年人和老年人的数量大大增加，而透析患者的总生存率仍然温和。根据患者特征估计预后，结合个人价值观和偏好考虑时，可能有助于老年人的透析决策。
Background: The elderly constitute the fastest-growing segment of the end-stage renal disease (ESRD) population, but the epidemiology and outcomes of dialysis among the very elderly, that is, those 80 years of age and older, have not been previously examined at a national level.Objective: To describe recent trends in the incidence and outcomes of octogenarians and nonagenarians starting dialysis.Design: Observational study.Setting: U.S. Renal Data System, a comprehensive, national registry of patients with ESRD.Participants: Octogenarians and nonagenarians initiating dialysis between 1996 and 2003.Measurements: Rates of dialysis initiation and survival.Results: The number of octogenarians and nonagenarians starting dialysis increased from 7054 persons in 1996 to 13 577 persons in 2003, corresponding to an average annual increase in dialysis initiation of 9.8%. After we accounted for population growth, the rate of dialysis initiation increased by 57% (rate ratio, 1.57 [95% CI, 1.53 to 1.62]) between 1996 and 2003. One-year mortality for octogenarians and nonagenarians after dialysis initiation was 46%. Compared with octogenarians and nonagenarians initiating dialysis in 1996, those starting dialysis in 2003 had a higher glomerular filtration rate and less morbidity related to chronic kidney disease but no difference in 1-year survival. Clinical characteristics strongly associated with death were older age, nonambulatory status, and more comorbid conditions.Limitations: Survival of patients with incident ESRD who did not begin dialysis could not be assessed.Conclusions: The number of octogenarians and nonagenarians initiating dialysis has increased considerably over the past decade, while overall survival for patients on dialysis remains modest. Estimates of prognosis based on patient characteristics, when considered in conjunction with individual values and preferences, may aid in dialysis decision making for the very elderly.