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老年患者的血液透析

Author
Jeffrey S Berns, MD
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD
Translators
刘迅, 主任医师

引言

在美国，于血液透析中心进行透析治疗是老年(大于75岁)终末期肾病(end-stage renal disease, ESRD)患者的主要治疗方式(96%)[1]。持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis, CAPD)或连续循环性腹膜透析(continuous cycler peritoneal dialysis, CCPD)约占3.5%，而仅有0.3%的患者接受家庭血液透析治疗[1]。

在过去的几十年中，美国接受透析患者的平均年龄呈稳定持续增长趋势。2000年，平均年龄约为62岁[2]。

开始进行透析的老年患者数量也在不断增长。一项利用美国肾脏数据系统(United States Renal Data System, USRDS)数据库的调查显示，80岁及以上开始透析治疗的患者自1996年的7054例增长到2003年的13,577例[3]。校正人口增长后，这段时间内，开始透析的患者数增长了57%。然而，与有相似程度肾功能障碍的较年轻患者相比，年长患者开始透析治疗的可能性也许较低。一项纳入加拿大亚伯达180多万成年人的社区队列研究表明了这点[4]。经过4.4年的随访，在研究开始时估计肾小球滤过率(glomerular filtration rate, GFR)为15-29mL/(min·1.73m2)的患者中，年龄大于85岁的患者中未经治疗的肾衰竭[定义为估计GFR<15mL/(min·1.73m2)]比例为18-44岁患者中的5倍多。这项研究无法确定患者不接受透析的个人原因[5]。

当评估伴ESRD年长患者的治疗时，需要考虑以下几个重要方面：

●此类患者的预期寿命

          

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Literature review current through: 2017-06 . | This topic last updated: 2016-01-08.
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