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【medical-news】是否进行血液透析——一项对75岁以
Background. The number of elderly patients with chronic kidney disease (CKD) stage 5 is steadily increasing. Evidence is needed to inform decision-making for or against dialysis, especially in those patients with multiple comorbid conditions for whom dialysis may not increase survival. We therefore compared survival of elderly patients with CKD stage 5, managed either with dialysis or conservatively (without dialysis), after the management decision had been made, and explored which of several key variables were independently associated with survival.
Methods. A retrospective analysis of the survival of all over 75 years with CKD stage 5 attending dedicated multidisciplinary pre-dialysis care clinics (n = 129) was performed. Demographic and comorbidity data were collected on all patients. Survival was defined as the time from estimated GFR <15 ml/min to either death or study endpoint.
Results. One- and two-year survival rates were 84% and 76% in the dialysis group (n = 52) and 68% and 47% in the conservative group (n = 77), respectively, with significantly different cumulative survival (log rank 13.6, P < 0.001). However, this survival advantage was lost in those patients with high comorbidity scores, especially when the comorbidity included ischaemic heart disease.
Conclusions. In CKD stage 5 patients over 75 years, who receive specialist nephrological care early, and who follow a planned management pathway, the survival advantage of dialysis is substantially reduced by comorbidity and ischaemic heart disease in particular. Comorbidity should be a major consideration when advising elderly patients for or against dialysis. Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5
是否进行血液透析?——75岁以上慢性肾病 (5期)患者的一项比较生存分析
Background. The number of elderly patients with chronic kidney disease (CKD) stage 5 is steadily increasing. Evidence is needed to inform decision-making for or against dialysis, especially in those patients with multiple comorbid conditions for whom dialysis may not increase survival. We therefore compared survival of elderly patients with CKD stage 5, managed either with dialysis or conservatively (without dialysis), after the management decision had been made, and explored which of several key variables were independently associated with survival.
背景：慢性肾病（CKD）老年患者的数量正稳步增长。需要证据作出透析与否的决定，尤其是伴多种疾病的患者，透析可能不能延长生存。因此我们比较了在决定管理之后，5期CKD老年患者在接受透析或保守治疗（未透析）的生存，分析与生存相关的独立的几种主要变量。
Methods. A retrospective analysis of the survival of all over 75 years with CKD stage 5 attending dedicated multidisciplinary pre-dialysis care clinics (n = 129) was performed. Demographic and comorbidity data were collected on all patients. Survival was defined as the time from estimated GFR <15 ml/min to either death or study endpoint.
方法：回顾性分析了来自透析前多科室监护门诊的年龄超过75岁的CKD5期患者的生存情况。收集所有患者的统计学和多种疾病资料。生存的定义为从估计GFR <15 ml/min 到死亡或研究终点的时间。
Results. One- and two-year survival rates were 84% and 76% in the dialysis group (n = 52) and 68% and 47% in the conservative group (n = 77), respectively, with significantly different cumulative survival (log rank 13.6, P < 0.001). However, this survival advantage was lost in those patients with high comorbidity scores, especially when the comorbidity included ischaemic heart disease.
结果：1年和2年生存率，透析组（52例）分别为84%、76%，保守治疗组（77例）分别为68%、47%，累积生存有显著性差别 (log rank 13.6, P < 0.001)。但是，在伴发病分数高的患者，尤其是伴发病包括缺血性心脏病中未显示益处。
Conclusions. In CKD stage 5 patients over 75 years, who receive specialist nephrological care early, and who follow a planned management pathway, the survival advantage of dialysis is substantially reduced by comorbidity and ischaemic heart disease in particular. Comorbidity should be a major consideration when advising elderly patients for or against dialysis.
结论：在超过75岁5期CKD患者，早期接受专家肾脏监护和接受计划的管理途径，由于伴发病，尤其是缺血性心脏病，透析的益处实际上是减少的。当建议老龄患者是否透析，伴发病是主要要考虑的因素。
编译： 是否进行透析?——75岁以上慢性肾病 (5期)患者的一项比较生存分析
背景：老年慢性肾病（CKD）5期患者的数目正在稳步增长。我们急需（循证医学）证据来作出对这些病人尤其是共患多种疾病的患者透析与否的建议，在这些病人中透析可能并不能延长生存时间。因此我们比较了接受透析或保守治疗（未透析）的5期CKD老年患者在治疗后的生存，分析了与生存相关的独立的几种主要变量。
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作者:admin@医学,生命科学 2011-03-10 17:11
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