老龄腹膜透析患者的临床特点及转归分析

Analysis on clinical features and outcome of elderly patients with peritoneal dialysis

目的探讨老龄腹膜透析患者的临床特点及影响生存率的相关因素。方法采用回顾性研究设计,筛选纳入空军军医大学西京医院2012年1月至2018年6月的起始年龄≥65岁腹膜透析患者,分析其临床数据,包括透析前及随访的相关临床及实验室数据,同时记录腹膜透析相关感染、预后等数据,进一步分析总体生存率和技术生存率及其相关影响因素。结果最终纳入78例老龄腹膜透析患者,其中原发性肾小球疾病35例(44.9%)、糖尿病肾病34例(43.6%)、高血压性肾损害6例(7.7%)、其他3例(3.8%)。随访过程中43例退出,其中39例死亡,死亡原因主要为心血管事件19例(48.7%)、腹膜透析相关性腹膜炎6例(15.4%)。老年腹膜透析患者中位生存时间为42(30.1,53.8)个月;中位技术生存时间为37(30.8,43.2)个月。老龄腹膜透析患者的5年生存率分别为86.8%、70.5%、53.9%、41.8%、32.5%;5年技术生存率分别为85.5%、67.9%、51.9%、35.1%、27.3%。死亡组与存活组间比较发现,透析充分性、糖尿病患病率、透析后血白蛋白、血钾、血钙水平和血小板计数存在统计学差异(均P<0.05)。多因素回归分析显示,透析后低蛋白血症、透析不充分为老龄腹膜透析患者死亡的独立危险因素。结论老龄腹膜透析患者具有较高的死亡率,透析后低蛋白血症、透析不充分为老龄腹膜透析患者死亡的独立危险因素。

Objective To explore the clinical features of elderly patients undergoing peritoneal dialysis and the related factors influencing their survival rate.Methods A retrospective study design was adopted,and those patients with peritoneal dialysis at the age≥65,treated in Xijing Hospital,the Air Force Medical University from Jan.2012 to Jun.2018,were enrolled.Their clinical data were analyzed,including the related clinical data and laboratory data before dialysis and during the follow-up;and the data on infection and prognosis associated with peritoneal dialysis were recorded.Overall and technical survival rates,and their influencing factors were analyzed further.Results Seventy-eight patients with peritoneal dialysis during the study period were enrolled,including 35 cases of primary glomerular diseases(44.9%),34 ones of diabetic nephropathy(43.6%),6 ones of hypertensive renal injury(7.7%),and 3 other ones(3.8%).During the follow-up,43 patients withdrew,of which 39 patients died.The death events included 19 cases of cardiovascular events(48.7%),and 6 cases of peritonitis associated with peritoneal dialysis(15.4%).The median survival time of elder patients with peritoneal dialysis was 42(30.1,53.8)months and the median technical survival time 37(30.8,43.2)months.The five-year survival rates were 86.8%,70.5%,53.9%,41.8%and 32.5%at 1,2,3,4 and 5 years after peritoneal dialysis initiation,respectively.The technical survival rates were 85.5%,67.9%,51.9%,35.1%and 27.3%at 1,2,3,4 and 5 years,respectively.Comparison between the survival group and the death group showed statistically significant differences in dialysis adequacy,diabetes,serum albumin,potassium,calcium levels and platelets after dialysis(P<0.05).Multivariate analysis showed that hypoalbuminemia and insufficient dialysis were independent factors of mortality in elder patients with peritoneal dialysis.Conclusions Mortality was higher in elderly patients.Factors affecting mortality in elderly patients included dialysis insufficient and the albumin levels after dialysis.