老年维持性血液透析患者第1年内的生存状况影响因素分析

The first year influencing factors for survival status in elderly maintenance hemodialysis patients

摘要:

目的 分析老年维持性血液透析(MHD)患者在开始透析第1年的生存状况，并探讨其影响因素。方法 选取2010年6月1日至2013年12月31日新入北京老年医院血液净化中心开始血液透析治疗的老年终末期肾病患者56例，所有患者随访观察1年，并收集其临床资料。根据是否死亡分为死亡组和存活组，先进行组间比较，再采用多因素logistic回归分析死亡危险因素。结果 随访观察1年后，56例患者中死亡22例,我院继续透析30例,分别归入死亡组和存活组,第1年内死亡率达39.3%，前3个月死亡率达17.9%；两组患者在合并糖尿病、合并充血性心力衰竭、C-G公式的估算肾小球滤过率、血清白蛋白、C-反应蛋白、主观全面评估（SGA）法评分等比较，差异均有统计学意义（P<0.05）；多因素logistic回归分析显示，原发病为糖尿病肾病、进入透析时合并充血性心力衰竭、透始肾小球滤过率、透始血清白蛋白、透始C-反应蛋白、透始SGA评分为老年MHD患者进入透析第1年内死亡的危险因素, 透始合并心力衰竭为最危险因素；死亡原因主要为心血管疾病（54.5%）和脑血管病（22.7%）。结论 老年终末期肾病患者是新入MHD患者的主要人群，其开始透析后1年内特别是3个月内死亡风险最高，心血管疾病为死亡的首要原因。关注并积极控制患者的死亡危险因素可能有助于提高老年MHD患者的早期生存率。

Abstract:

Objective To analyze the survival status of elderly patients receiving maintenance hemodialysis (MHD) during the first year of dialysis. Methods Fifty-six elderly patients with end stage renal disease who were newly admitted in Blood Purification Center of Beijing Geriatric Hospital from 1 June, 2010 to 31 December, 2013 for hemodialysis were recruited in this study. All the patients were followed up for 1 year, and their clinical data were collected. According to the outcomes, the patients were divided into the death group and survival group. The data were compared between the 2 groups, and multivariate logistic regression analysis was used to analyze the risk factors for death. Results At the end of 1 year’s follow-up, 22 cases died. They were assigned into the death group, and the other 30 cases who received continued dialysis in our Center were into the survival group. The mortality within the first year of dialysis was 39.3%, and was 17.9% in the first 3 months. There were significant differences in the percentages of the patients complicated with diabetes and congestive heart failure, estimated glomerular filtration rate (eGFR, calculated by the C-G formula), serum levels of albumin and C-reactive protein, and subjective global assessment (SGA) scores of nutritional status between the 2 groups (P<0.05). Multivariate logistic regression analysis showed that diabetic nephropathy as primary disease, and eGFR, albumin, C-reactive protein, SGA score and complication of congestive heart failure at the beginning of dialysis were risk factors for death in the MHD patients within the first year of dialysis. Among them, complication with congestive heart failure at the beginning of dialysis was the most dangerous factor. The main causes of death were cardiovascular disease (54.5%) and cerebrovascular disease (22.7%). Conclusion Elderly patients with end-stage renal disease are the majority for MHD. They are at high risk of death within the first year of dialysis, especially the first 3 months. Cardiovascular disease is main cause of death. Clinicians should pay attention to and vigorously control the risk factors of death in order to promote the early survival rate for the elderly MHD patients.