Strategies for the Super-Aged Dialysis Population: Survival Benefits or Alternative Goals?
Strategies for the Super-Aged Dialysis Population: Survival Benefits or Alternative Goals?
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针对超高龄透析人群的策略：生存获益还是替代目标？
DOI：
10.1159/000496660
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Nangaku M.
中科院分区：
文献类型：
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作者：
Sakurai S;Hanafusa N;Nomura T;Tsuchiya K;Nitta K;Nangaku M.
背景/目的日本人口老龄化具有显著的流行病学和患者特征。≥70岁以上的血液透析患者数量正在增加。年龄调整后的死亡率正在改善，但一些特定原因的死亡率保持不变，包括传染病和恶性肿瘤，需要采取积极的战略。然而，90岁或以上患者的生存趋势尚不清楚。方法我们查阅了日本透析治疗学会肾脏数据登记处1987年至2014年报告的年度数据，以确定生存趋势。结果超高龄组(≥90岁)的生存大多仍未得到改善。在特定原因的生存方面，尤其是心力衰竭导致的死亡，这一组患者与其余老年患者之间存在明显差异，表明提高他们的生存是困难的。因此，可以考虑替代的透析目标。该人群的主要透析目标可能是维持生活质量和限制功能损害。结论在过去的20年中，高龄人群的存活率并没有提高。因此，对于90岁或以上的患者来说，停止或停止透析并提供保守治疗而不进行透析治疗可能是一个重要的选择。
Background/AimsJapan’s aging population has prominent epidemiological and patient characteristics. The number of hemodialysis patients aged≥ 70 years is increasing. Age-adjusted mortality is improving, but some cause-specific mortalities remain unchanged, including infectious disease and malignancy, requiring combative strategies. However, survival trends for patients aged 90 years or older are not known.MethodsWe examined annual data reported by the Japanese Society for Dialysis Therapy Renal Data Registry for the period 1987–2014 to determine survival trends.ResultsSurvival in the super-aged group (≥ 90 years) is still mostly unimproved. In terms of cause-specific survival, especially death due to heart failure differs distinctly between this group and the remaining elderly patients, indicating that improving their survival is difficult. Alternative dialysis goals could therefore be considered. The major dialysis objective in this population could be to maintain quality of life and limit functional impairment.ConclusionSurvival of the super-aged population has not improved in the last 2 decades. Thus, withholding or withdrawing dialysis and providing conservative management without dialysis treatment could be an important option for patients aged 90 years or older.