Evaluation of unplanned dialysis as a predictor of mortality in elderly dialysis patients: a retrospective data analysis
Evaluation of unplanned dialysis as a predictor of mortality in elderly dialysis patients: a retrospective data analysis
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DOI：
10.1186/s12882-017-0778-0
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发表时间：
2017-12-19
期刊：
影响因子：
2.3
通讯作者：
Kam, Jia Wen
中科院分区：
文献类型：
--
作者：
Roy, Debajyoti;Chowdhury, Anupama Roy;Kam, Jia Wen
背景：越来越多的老年患者正在接受长期透析。然而，透析在生存和生活质量中的作用尚不清楚，不良结局可能与合并症有关，而不仅仅是与年龄有关。据报告，慢性肾脏病（CKD）老年患者开始计划外透析与生存率低相关。我们评估了患者和实践因素相关的生存率差。方法：我们进行了回顾性分析，连续90例老年患者（≥ 75岁）慢性肾脏病开始长期透析，在我们的肾脏单位2010年10月和2014年2月之间。排除6例患者;对84名接受计划或非计划透析的终末期肾病患者（>= 75岁）的数据进行分析。患者随访至死亡或2015年1月。患者因素如开始透析时的年龄和合并症（即，糖尿病、缺血性心脏病[IHD]、外周血管疾病、癌症、慢性阻塞性肺病和认知功能障碍）。实践因素，如计划或计划外的透析开始进行了比较与生存结局。"计划外透析"定义为已知CKD 4期或5期患者在透析开始前3个月内未接受肾病学家评估。透析开始时的平均年龄为81.5 ± 4.5岁，血清白蛋白水平为24.8 ± 6 g/L，体重指数为22.5 ± 4.8 kg/m2，糖化血红蛋白A1c水平为6.3 ± 1.3。总体而言，分别有51例（61%）和33例（39%）患者接受了计划外和计划内透析。在单变量分析中，缺血性心脏病、外周血管疾病、≥ 3种合并症和计划外透析与死亡显著相关。在多变量分析中，非计划透析开始、缺血性心脏病和外周血管疾病仍具有显著性。计划外透析与计划内透析的3个月和12个月生存率分别为38.6%和90.9%，14.4%和73.6%（p <0.001）。非计划透析与更高的死亡率显著相关。结论：在老年透析患者中，非计划透析开始与生存率低相关。患者特征（例如相关的外周血管疾病和IHD）与生存率低相关。
Background: Increasing numbers of elderly patients are undergoing long-term dialysis. However, the role of dialysis in survival and quality of life is unclear, and poor outcomes may be associated with comorbidities rather than with age only. The initiation of unplanned dialysis in elderly patients with chronic kidney disease (CKD) has been reported to be associated with poor survival. We evaluated patient and practice factors associated with poor survival.Methods: We performed a retrospective analysis of 90 consecutive elderly patients (>= 75 years) with CKD initiated on long-term dialysis at our renal unit between October 2010 and February 2014. Six patients were excluded; data from 84 remaining patients (>= 75 years) with end-stage renal disease undergoing planned or unplanned dialysis were analyzed. Patients were followed up until death or January 2015. Patient factors such as age at initiation of dialysis and comorbidities (i.e., diabetes mellitus, ischemic heart disease [IHD], peripheral vascular disease, cancer, chronic obstructive pulmonary disease, and cognitive dysfunction) were analyzed. Practice factors such as planned or unplanned initiation of dialysis were compared in relation to survival outcomes. "Unplanned dialysis" was defined as a patient with known CKD stage 4 or 5 who had not been evaluated by a nephrologist in the 3 months before dialysis initiation.Results: The average age at dialysis initiation was 81.5 +/- 4.5 years), serum albumin level was 24.8 +/- 6 g/L, body mass index was 22.5 +/- 4.8 kg/m(2), and glycated hemoglobin A1c level was 6.3 +/- 1.3. Overall, 51 (61%) and 33 (39%) patients underwent unplanned and planned dialysis, respectively. On univariate analysis, the presence of IHD, peripheral vascular disease, >= 3 comorbidities, and unplanned initiation of dialysis were significantly related to death. On multivariate analysis, unplanned start of dialysis, ischemic heart diseases and peripheral vascular disease remained significant. Survival rates at 3 and 12 months were 38.6% vs. 90.9% and 14.4% vs. 73.6% for unplanned vs. planned dialysis, respectively (p < 0.001). Unplanned dialysis was significantly associated with greater mortality.Conclusions: In elderly dialysis patients, unplanned start of dialysis was associated with poor survival. Patient characteristics such as associated peripheral vascular disease and IHD were associated with poor survival.