老年血液透析患者生存现状及血管通路方式对生存时间的影响

The survival status of elderly hemodialysis patients and the effect of dialysis pathway on survival

目的观察老年血液透析患者生存期临床特点,并探讨不同血管通路方式对老年患者生存的影响。方法选取2017年1月─2021年12月在杭州市中医院开始行血液透析且治疗时间大于3个月的老年患者(年龄≥60岁)为研究对象,收集患者相关资料,观察截至2022年6月30日,终点事件为全因死亡。将血管通路为自体动静脉内瘘(autogenous arteriovenous fistula,AVF)分为内瘘组,血管通路为带隧道和涤纶套的透析导管(tunnel-cuffed catheter,TCC)分为导管组,使用Kaplan-Meier法分析2组生存率,Log-rank检验比较生存率差异,COX回归分析不同血管通路方式对老年血液透析患者预后的影响。结果共纳入133例老年患者,其中32例死亡。死亡原因为心血管事件、多脏器衰竭和恶性肿瘤。原发病中糖尿病肾病和慢性肾小球肾炎各占45.11%和44.36%。血管通路方式中AVF比例为72.93%,TCC比例27.07%。内瘘组和导管组患者年龄(Z=6.177,P<0.001)、血红蛋白(Z=2.489,P=0.013)、血肌酐(t=2.687,P<0.001)、白蛋白(Z=2.093,P<0.001)及超敏C反应蛋白(hs-CRP)(Z=4.872,P<0.001)比较存在统计学差异。AVF组患者12、24、36个月生存率为93.2%、84.1%、71.4%,TCC组为74.5%、53.0%、37.6%。Log-rank检验结果显示内瘘组和导管组患者5年累积生存率存在统计学差异(χ^(2)=22.665,P<0.001)。多因素COX回归显示TCC对老年透析患者生存时间的影响具有统计学意义(HR=0.420,95%CI:0.183~0.963,P=0.040)。结论老年透析患者主要死亡原因为心血管事件、多脏器衰竭和恶性肿瘤。糖尿病肾脏和慢性肾小球肾炎为常见病因。TCC是影响老年透析患者生存时间的独立危险因素。

Objective To observe the clinical characteristics of elderly patients(≥60 years old)managed with maintenance hemodialysis(MHD)and to investigate the effect of vascular access type on survival of the patients.Methods Patients beginning hemodialysis in the period from January 1,2017 to December 31,2021 were recruited as the research subjects.They were followed up until June 31,2022,and the endpoint was all-cause death in the follow-up period.According to vascular access type,patients were divided into 2 groups:autologous arteriovenous fistula group(AVF group)and tunneled cuffed catheter group(TCC group).Kaplan-Meier method was used to analyze the survival rate.Log-rank test was used to compare the survival rate.Cox regression model was performed to analyze the influencing factors.Results A total of 133 elderly MHD patients were included in this study,and 33 patients died.The top three death causes were cardiovascular events,multiple organ failure and malignant tumors.The primary diseases were diabetic nephropathy(45.11%)and chronic glomerulonephritis(44.36%).Among the 133 MHD patients,72.93% used AVF(AVF group)and 27.07% used TCC(TCC)group as the vascular access.There were differences in age(Z=6.177,P<0.001),Hb(Z=2.489,P=0.013),blood creatinine(t=2.687,P<0.001),albumin(Z=2.093,P<0.001),and hs-CRP(Z=4.872,P<0.001)between the two groups.After 12,24,36 months,the survival rates in AVF group were 93.2%,84.1%and 71.4%respectively,and the survival rates in TCC group were 74.5%,53.0% and 37.6% respectively.Log-rank test demonstrated that the survival rate was lower in TCC group than in AVF group(χ^(2)=22.665,P<0.001).Multivariate COX regression indicated that TCC was an independent risk factor for survival in elderly MHD patients(HR=0.420,95%CI:0.183~0.963,P=0.040).Conclusions In elderly MHD patients,the top there death causes are cardiovascular events,multiple organ failure and malignant tumors,and the main primary diseases are diabetes mellitus and chronic glomerulonephritis.Patients using TCC as the vascular access have a lower survival rate,and TCC for vascular access is an independent risk factor for survival in elderly MHD patients.