目的 探讨老年血液透析患者首次透析的原发病因,特别是老年糖尿病肾病(diabetic nephropathy,DN)患者启动透析时的特点,为老年DN患者何时启动透析治疗提供依据。方法 对2014-01至2018-12血透中心新增的146例老年患者的病因、化验结果及发生并发症的情况进行了分析,并分析DN和非DN患者上述指标差异。结果 146例老年透析患者的病因以DN(56.8%)、慢性肾小球肾炎(15.8%)、高血压(17.8%)为主,心功能不全/水肿、贫血、冠心病、脑梗死的发生率分别为79.45%、41.10%、 29.45%、19.18%。DN患者开始透析时与非DN患者相比,血肌酐水平低[(520.90±244.30)μmol/L vs (704.90±204.34) μmol/L],贫血严重[(88.44±14.35) g/L vs (95.87±16.28)g/L]和全段甲状旁腺素(intact parathyroid hormone, iPTH)低[(186.98±122.59) pg/L vs (253.29±125.80) pg/L ]。DN患者开始透析的主要原因为心功能不全/水肿,血肌酐的水平比非DN患者水平更低。临时中心静脉置管在开始透析时最为常用。结论 老年患者首次透析第一位的病因为DN,其次是高血压肾病。DN患者进入透析时常合并有心功能不全/水肿等并发症,而且发生率高。DN患者启动透析的时机需要更早些。
Abstract
Objective To explore the characteristics of elderly patients who received hemodialysis for the first time and the differences in clinical manifestations and reasons for initiating dialysis between the diabetic nephropathy(DN)group and non-DN group.Methods The etiology, complications and laboratory examination results of 146 elderly patients with hemodialysis were analyzed, who had been treated between January 2014 and December 2018 in the Hemodialysis Center of our hospital. The differences of the above indexes between DN and non-DN patients were studied.Results Diabetic nephropathy (56.8%), chronic glomerulonephritis (15.8%) and hypertension (17.8%) were the main causes of hemodialysis for these elderly patients. The incidences of cardiac insufficiency/edema, anemia, coronary heart disease and cerebral infarction were 79.45%, 41.10%, 29.45% and 19.18%,respectively. During the initial dialysis in DN patients, the serum creatinine 1evel (520.90±244.30)μmol/L was 1ower than that of the non-diabetic group (704.90±204.34) μmol/L, anemia was more severe [(88.44±14.35) g/L vs(95.87±16.28)g/L], and iPTH levels were lower [(186.98±122.59) pg/L vs (253.29±125.80) pg/L]. Cardiac insufficiency/edema was the main cause of HD in DN patients, and serum creatinine levels were lower than those of the non-DN patients. Most patients initiated hemodialysis with central venous catheterization as the blood access.Conclusions Diabetic nephropathy is the dominating cause of initial dialysis among elderly patients, followed by hypertensive nephropathy and chronic glomerulonephritis. Severe complications can occur during hemodialysis. DN patients should initiate HD earlier due to cardiac insufficiency/edema.
关键词
老年 /
血液透析 /
原发病因 /
糖尿病肾病
Key words
elderly /
hemodialysis /
primary diseases /
diabetic nephropathy
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参考文献
[1] Collins A J, Foley R N, Chavers B, et al. United States Renal Data System 2011 Annual Data Report: Atlas of chronic kidney disease & end-stage renal disease in the United States[J]. Am J Kidney Dis, 2012, 59(1 Suppl 1):A7, e1-e420.
[2] 涂晓文, 王 欢, 赵雯雯, 等. 高通量血液透析对维持性血液透析患者左心室结构和功能的影响[J]. 武警医学, 2014, 25(8):793-796.
[3] Guney I, Atalay H, Solak Y, et al. Poor quality of life is associated with increased mortality in maintenance hemodialysis patients: a prospective cohort study [J]. Saudi J Kidney Dis Transpl, 2012, 23(3): 493-499.
[4] Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China [J]. N Engl J Med, 2010, 362(12):1090-1191.
[5] 安 娜, 黎吉锋, 李 洪. 单中心2272例新增维持性血液透析患者的病因构成及其变迁[J]. 海南医学, 2015, 26(19): 2834-2837.
[6] Cooper B A, Branley P, Bulfone L, et al. A randomized, controlled trial of early versus late initiation of dialysis[J]. N Engl J Med, 2010, 363(7):609-619.
[7] Tamura M K, Tan J C, O’Hare A M. Optimizing renal replacement therapy in older adults: a framework for making individualized decisions[J]. Kidney Int, 2012, 82(3):261-269.
[8] Kurella M, Covinsky K E, Collins A J, et al. Octogenarians and nonagenarians starting dialysis in the United States[J]. Ann Intern Med, 2007, 146(3):177-183.
[9] Besarab A. Access monitoring is worthwhile and valuable [J]. Blood Purif, 2006, 24(1):77-89.
[10] 涂天琪, 涂晓文. 老年血液透析患者血管通路的建立选择与维护[J]. 中国中西医结合肾病杂志, 2018, 19(10): 917-919.
[11] Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access [J]. Am J Kidney Dis, 2006, 48(Suppl 1): S176-S247.
[12] 中国医院协会血液净化中心管理分会血液净化通路学组. 中国血液透析用血管通路专家共识(第1版)[J]. 中国血液净化, 2014,13(8): 549-558.
[13] Wasse H, Kutner N, Zhang R, et al. Association of initial hemodialysis vascular access with patient-reported health status and quality of life[J]. Clin J Am Soc Nephrol, 2007, 2(4):708-714.
[14] Allon M. Current management of vascular access [J]. Clin J Am Soc Nephrol, 2007, 2(4): 786-800.
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