高龄老年血液透析患者的生存分析  

Survival analysis of hemodialysis patients aged 80 years and over

作　　者：郑志贵[1] 何东元[1] 陈宜方[1] 陈建国[1] Zheng Zhigui;He Dongyuan;Chen Yifang;Chen Jianguo(Department of Nephrology,Zhejiang Hospital,Hangzhou 310013,China)

机构地区：[1]浙江医院肾内科,杭州310013

出　　处：《中华老年医学杂志》2020年第5期559-563,共5页Chinese Journal of Geriatrics

摘　　要：目的了解80岁及以上老年血液透析患者长期生存率及影响因素。方法回顾性分析2008年5月至2017年5月在我科确诊为终末期肾脏病并行血液透析超过3个月,始透年龄≥80岁的82例患者临床资料,Kaplan-Meier法分析患者的生存率,运用Log-rank检验比较≥80岁高龄血液透析患者和76例80岁以下的血液透析患者的生存率,Cox回归模型分析影响高龄血液透析患者预后的影响因素。结果82例80岁及以上老年血液透析患者中位生存时间为34个月,6、12、24和36个月的生存率分别为90.0%、73.6%、60.8%和49.4%,主要死亡原因前3位依次为心血管事件、感染性休克、恶性肿瘤;80岁以下维持性血液透析患者中位生存时间为52个月,6、12、24和36个月的生存率分别为94.7%、85.5%、72.4%和65.8%;经Log-rank检验结果显示,80岁及以上高龄血液透析患者的生存率低于80岁以下患者(χ^2=5.284,P=0.022)。多因素Cox回归分析结果显示,合并糖尿病是影响80岁及以上高龄血液透析患者生存的独立危险因素(HR=3.470,95%CI:1.364~8.827,P=0.009),而体质指数(BMI)(HR=0.806,95%CI:0.706~0.921,P=0.001)和人血白蛋白水平(HR=0.861,95%CI:0.789~0.938,P=0.001)为80岁及以上高龄血液透析患者生存的独立保护性因素。结论80岁及以上高龄血液透析患者的生存率低于80岁以下患者,主要死亡原因为心血管事件、感染性休克和恶性肿瘤,影响高龄血液透析患者生存的主要危险因素为合并糖尿病、BMI偏低和白蛋白水平偏低。Objective To investigate the long-term survival rate and the influencing factors for prognosis in patients aged 80 years and over who underwent hemodialysis.Methods Clinical data of 82 patients with end stage renal disease(ESRD)who started dialysis in≥80 years of age and underwent hemodialysis for more than three months in our hospital from May 2008 to May 2017 were retrospectively analyzed.Kaplan-Meier method was used to analyze the survival rate of patients.Log-rank test was used to compare survival rate of hemodialysis patients aged≥80 years versus aged<80 years.Cox regression model was performed to analyze the influencing factors for prognosis in elderly patients undergoing hemodialysis.Results The median survival time of 82 hemodialysis patients aged≥80 years was 34 months,and their 6-month,12-month,24-month and 36-month survival rates were 90.0%,73.6%,60.8%and 49.4%,respectively.The top three death causes were cardiovascular events,septic shock,and malignant tumors.The median survival time of the hemodialysis patients aged<80 years was 52 months,and their 6-month,12-month,24-month and 36-month survival rates were 94.7%,85.5%,72.4%and 65.8%,respectively.Log-rank test demonstrated that the survival rate was lower in patients aged≥80 years than in patients aged<80 years(χ^2=5.284,P=0.022).Multivariate Cox regression analysis indicated that diabetes mellitus was an independent risk factor for the survival in hemodialysis patients aged≥80 years(HR=3.470,95%CI:1.364~8.827,P=0.009),while targeted levels of body mass index(BMI)(HR=0.806,95%CI:0.706~0.921,P=0.001)and serum albumin level(HR=0.861,95%CI:0.789~0.938,P=0.001)were the independent protective factors for the survival in hemodialysis patients aged≥80 years.Conclusions The survival rate is lower in hemodialysis patients aged≥80 years than in those aged<80 years.The top death causes is cardiovascular events,septic shock,and malignant tumors.Diabetes mellitus,low levels of BMI and serum albumin are the main risk factors for the survival in advan

关 键 词：肾透析 预后 

分 类 号：R692.5[医药卫生—泌尿科学]