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目的探讨80岁以上老年人透析决策。方法观察80岁以上老年患者生活质量(Qo L)和临床特征,采用竞争风险分析方法评估透析启动和死亡的预测因素。结果 160例患者估计肾小球滤过率(e GFR)<45 ml/(min×1.73 m2)。多数患者无贫血性血红蛋白水平(Hb),亦无铁缺乏,正常钙和正常磷水平。所有患者饮食良好,均为正常认知功能和良好的Qo L。3年内病死率为27%,透析启动为11%。导致死亡的主要原因为心血管(32%)、亚病质(18%)、肿瘤(9%)、感染(3%)、外伤(3%)、痴呆(3%)、其他不明原因(32%)。透析启动原因包括高血钾或酸血症(71%),未控制的消化疾病(35%)、肺或末稍水肿(29%)、营养不良(12%)。死亡有预测因素包括急性充血性心力衰竭、年龄、步行功能受损、Hb<100 g/L。对于透析启来说,e GFR<23 ml/(min×1.73 m2)、舒张期血压与透析启动独立相关。结论 80岁以上老年的透析决策应根据尿毒症标准来严格选择。
Objective To explore the dialysis decision-making in the elderly over 80 years old. Methods The quality of life (QoL) and clinical features of elderly patients over 80 years of age were observed. Competitive risk analysis was used to assess predictors of dialysis initiation and death. Results 160 patients were estimated glomerular filtration rate (e GFR) <45 ml / (min × 1.73 m2). Most patients have no anemia hemoglobin (Hb), nor iron deficiency, normal calcium and normal phosphorus levels. All patients had a good diet, both normal cognitive function and good QoL. The mortality rate was 27% in 3 years and 11% in dialysis. The main causes of death are cardiovascular (32%), suboplasme (18%), cancer (9%), infection (3%), trauma (3%), dementia (3%), other unexplained %). Causes of dialysis include hyperkalemia or acidosis (71%), uncontrolled digestive diseases (35%), pulmonary or peripheral edema (29%), malnutrition (12%). Predictors of death include acute congestive heart failure, age, impaired walking function, and Hb <100 g / L. For dialysis, e GFR <23 ml / (min x 1.73 m2), diastolic blood pressure was independently associated with dialysis initiation. Conclusion The decision-making of dialysis in the elderly over the age of 80 should be strictly based on the standard of uremia.