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中华肾病研究电子杂志 ›› 2018, Vol. 07 ›› Issue (01) : 39 -43. doi: 10.3877/cma.j.issn.2095-3216.2018.01.009

所属专题: 文献

综述

老年维持性血液透析患者死亡危险因素研究进展
宋玉环1, 蔡广研2,(), 肖跃飞3, 陈香美2   
  1. 1. 100853 北京,解放军总医院肾脏病科、解放军肾脏病研究所、肾脏疾病国家重点实验室、国家慢性肾病临床医学研究中心;100049 北京大学航天临床医学院、航天中心医院肾脏内科
    2. 100853 北京,解放军总医院肾脏病科、解放军肾脏病研究所、肾脏疾病国家重点实验室、国家慢性肾病临床医学研究中心
    3. 100049 北京大学航天临床医学院、航天中心医院肾脏内科
  • 收稿日期:2017-11-16 出版日期:2018-02-28
  • 通信作者: 蔡广研
  • 基金资助:
    国家科技支撑计划课题(2015BAI12B06, 2011BAI10B03)

Progress of research on mortality risk factors in elderly patients undergoing maintenance hemodialysis

Yuhuan Song1, Guangyan Cai2,(), Yuefei Xiao3, Xiangmei Chen2   

  1. 1. Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853; Department of Nephrology, Aerospace Central Hospital, Peking University School of Aerospace Clinical Medicine, Beijing 100049, China
    2. Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853
    3. Department of Nephrology, Aerospace Central Hospital, Peking University School of Aerospace Clinical Medicine, Beijing 100049, China
  • Received:2017-11-16 Published:2018-02-28
  • Corresponding author: Guangyan Cai
  • About author:
    Corresponding author: Cai Guangyan, Email:
引用本文:

宋玉环, 蔡广研, 肖跃飞, 陈香美. 老年维持性血液透析患者死亡危险因素研究进展[J]. 中华肾病研究电子杂志, 2018, 07(01): 39-43.

Yuhuan Song, Guangyan Cai, Yuefei Xiao, Xiangmei Chen. Progress of research on mortality risk factors in elderly patients undergoing maintenance hemodialysis[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2018, 07(01): 39-43.

随着人均寿命的延长、代谢性疾病和动脉粥样硬化发病率的不断上升和血液净化技术的不断改进,老年维持性血液透析(MHD)患者数量逐年增加。由于老年患者独特的生理特点及合并症的增加,老年MHD患者的生活质量及生存率均不及中青年患者,死亡率仍较高。常见死亡原因有心脑血管疾病、感染、消化道出血及肿瘤等。诸多死亡危险因素中包括了年龄、合并糖尿病、高血压、营养不良、血管通路类型及心理疾患等。本文系统综述了老年血液透析患者的死亡原因及相关危险因素的研究进展,为临床进行前瞻干预提供依据。

With the increase of average life expectancy of humanity, the rising of incidences of metabolic diseases and atherosclerosis, and the continuous improvement of blood purification technology, the number of elderly patients with maintenance hemodialysis (MHD) increases year by year. Due to the unique physiological characteristics and the increase of comorbidities in elderly patients, the elderly MHD patients have lower quality of life and lower survival rate, but higher mortality rate than the young and middle-aged patients. The common causes of death include cardiovascular and cerebrovascular diseases, infections, gastrointestinal bleeding, and tumors. Many death risk factors include age, diabetes mellitus, hypertension, malnutrition, types of vascular access, and mental disorders. This article systematically elaborated the research progress of the causes of death and related risk factors in elderly hemodialysis patients, so as to provide evidence for clinical prospective interventions.

[1]
Polikandrioti M, Koutelekos I, Vasilopoulos G, et al. Hemodialysis patients' information and associated characteristics [J]. Mater Sociomed, 2017, 29(3): 182-187.
[2]
Glaudet F, Hottelart C, Allard J, et al. The clinical status and survival in elderly dialysis: example of the oldest region of France [J]. BMC Nephrol, 2013, 25(14): 131.
[3]
Lee JE, Lim JH, Jang HM, et al. Low serum phosphate as an independent predictor of increased infection-related mortality in dialysis patients: a prospective multicenter cohort study [J]. PLoS One, 2017, 12(10): e0185853.
[4]
Jung SM, Kim CT, Kang EW, et al. Dementia is a risk factor for major adverse cardiac and cerebrovascular events in elderly Korean patients initiating hemodialysis: a Korean national population-based study [J]. BMC Nephrol, 2017, 18(1): 128.
[5]
Lee T, Thamer M, Zhang Q, et al. Vascular access type and clinical outcomes among elderly patients on hemodialysis [J]. Clin J Am Soc Nephrol, 2017, 12(11): 1823-1830.
[6]
Nagai K, Matsuura M, Tsuchida K, et al. Prognostic factors for mortality in middle-aged and older hemodialysis patients: a 5-year observational study [J]. J Artif Organs, 2017, [Epub ahead of print].
[7]
Sladoje-Martinovic B, Mikolasevic I, Bubic I, et al. Survival of chronic hemodialysis patients over 80 years of age [J]. Clin Interv Aging, 2014, 16(9): 689-696.
[8]
Roberts PR, Zachariah D, Morgan JM, et al. Monitoring of arrhythmia and sudden death in a hemodialysis population: the CRASH-ILR Study [J]. PLoS One, 2017, 12(12): e0188713.
[9]
王静.老年血液透析患者死亡原因分析 [J].山西职工医学院学报,2013,23(5):26-27.
[10]
赵伟,戈艳蕾.血液透析患者血清软骨寡聚基质蛋白浓度与血管钙化及心血管事件关系的探讨[J].中国血液净化,2011,5(10):254-257.
[11]
Delmez JA, Yan G, Bailey J, et al. Cerebrovascular disease in maintenance hemodialysis patients: results of the HEMO Study [J]. Am J Kidney Dis, 2006, 47(1): 131-138.
[12]
Allon M, Depner TA, Radeva M. Impact of dialysis dose and membrane on infection-related hospitalization and death: results of the HEMO Study [J]. J Am Soc Nephrol, 2003, 14(7): 1863-1870.
[13]
王质刚. 血液透析学[M ] .北京:北京科学技术出版社,1992: 236-239.
[14]
Delmez JA, Yan G, Bailey J, et al. Cerebrovascular disease in maintenance hemodialysis patients: results of the HEMO Study [J]. Am J Kidney Dis, 2006, 47(1): 131-138.
[15]
Trivedi H, Yang J, Szabo A. Gastrointestinal bleeding in patients on long-term dialysis [J]. J Nephrol, 2015, 28(2): 235-243.
[16]
Martindale JL, Aherne A, Sinert R. Sudden cardiac death in a dialysis patient: hyperkalemia reconsidered [J]. J Emerg Med, 2014, 47(3): e73-e76.
[17]
Chapman RJ, Templeton M, Ashworth S, et al. Long-term survival of chronic dialysis patients following survival from an episode of multiple-organ failure [J]. Crit Care, 2009, 13(3): R65.
[18]
张怡玲,尹永红,赵久阳. 透析患者并发恶性肿瘤的临床分析[J].大连医科大学学报,2010,32(5) : 556-557.
[19]
Ma L, Zhao S. Risk factors for mortality in patients undergoing hemodialysis: A systematic review and meta-analysis [J]. Int J Cardiol, 2017, 1(238): 151-158.
[20]
Lin YT, Wu PH, Kuo MC, et al. High cost and low survival rate in high comorbidity incident elderly hemodialysis patients [J]. PLoS One, 2013, 8(9): e75318.
[21]
Soleymanian T, Niyazi H, Noorbakhsh Jafari Dehkordi S, et al. Predictors of clinical outcomes in hemodialysis patients: a multicenter observational study [J]. Iran J Kidney Dis, 2017, 11(3): 229-236.
[22]
Matsubara Y, Kimachi M, Fukuma S, et al. Development of a new risk model for predicting cardiovascular events among hemodialysis patients: population-based hemodialysis patients from the Japan Dialysis Outcome and Practice Patterns Study (J-DOPPS) [J]. PLoS One, 2017, 12(3): e0173468.
[23]
Banaga AS, Mohammed EB, Siddig RM, et al. Causes of end stage renal failure among haemodialysis patients in Khartoum State/Sudan [J]. BMC Res Notes, 2015, 29(8): 502.
[24]
Ceretta ML, Noordzij M, Luxardo R, et al. Changes in co-morbidity pattern in patients starting renal replacement therapy in Europe-data from the ERA-EDTA Registry [J]. Nephrol Dial Transplant, 2018, [Epub ahead of print].
[25]
张桂华.老年患者维持性血液透析死亡原因分析[J].中国误诊学杂志,2004,4(2):213-214.
[26]
Lee T, Thamer M, Zhang Q, et al. Vascular access type and clinical outcomes among elderly patients on hemodialysis [J]. Clin J Am Soc Nephrol, 2017, 12(11): 1823-1830.
[27]
Oliva JS, Roa LM, Lara A, et al. Survival and factors predicting mortality in hemodialysis patients over 75 years old [J]. J Nephrol, 2013, 26(1): 129-135.
[28]
Zhang JC, Al-Jaishi AA, Na Y, et al. Association between vascular access type and patient mortality among elderly patients on hemodialysis in Canada [J]. Hemodial Int, 2014, 18(3): 616-624.
[29]
Praga M, Merello JI, Palomares I, et al. Type of vascular access and survival among very elderly hemodialysis patients [J]. Nephron Clin Pract, 2013, 124(1-2): 47-53.
[30]
罗丽花,管保章,黄思博,等.老年维持性血液透析患者的临床特征分析 [J].临床肾脏病杂志,2016,16(6):350-354.
[31]
Zingerman B, Korzets A, Ori Y, et al. The very old on hemodialysis: 8 years' experience in a single unit [J]. Blood Purif, 2014, 37(1): 12-17.
[32]
Port FK, Pisoni RL, Bommer J, et al. Improving outcomes for dialysis patients in the international Dialysis Outcomes and Practice Patterns Study [J]. Clin J Am Soc Nephrol, 2006, 1(2): 246-255.
[33]
Hatakeyama S, Murasawa H, Hamano I, et al. Prognosis of elderly Japanese patients aged ≥80 years undergoing hemodialysis [J]. ScientificWorldJournal, 2013, 2013: 693514.
[34]
Anand IS, Chandrashekhar Y, Ferrari R, et al. Pathogenesis of oedema in chronic severe anaemia: studies of body water and sodium, renal function, haemodynamic variables, and plasma hormones [J]. Br Heart J, 1993, 70(4): 357-362.
[35]
Kataoka H, Tsuchiya K, Naganuma T, et al. Relationship between anaemia management at haemodialysis initiation and patient prognosis [J]. Nephrology (Carlton), 2015, 20 (Suppl 4): 14-21.
[36]
姚名辉,高长青,王嵘,等.青年与老年冠心病患者行冠状动脉旁路移植术疗效及危险因素分析[J].解放军医学院学报,2013,34(7):696-699.
[37]
Kutner NG, Zhang R. Body mass index as a predictor of continued survival in older chronic dialysis patients [J]. Int Urol Nephrol, 2001, 32(3): 441-448.
[38]
Vashistha T, Mehrotra R, Park J, et al. Effect of age and dialysis vintage on obesity paradox in long-term hemodialysis patients [J]. Am J Kidney Dis, 2014, 63(4): 612-622.
[39]
Jialin W, Yi Z, Weijie Y. Relationship between body mass index and mortality in hemodialysis patients: a meta-analysis [J]. Nephron Clin Pract, 2012, 121(3-4): c102-c111.
[40]
Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease [J]. Am J Kidney Dis, 1998, 32(5 Suppl 3): S112-S119.
[41]
Park JY, Yoo KD, Kim YC, et al. Early dialysis initiation does not improve clinical outcomes in elderly end-stage renal disease patients: a multicenter prospective cohort study [J]. PLoS One, 2017, 12(4): e0175830.
[42]
Lassalle M, Labeeuw M, Frimat L, et al. Age and comorbidity may explain the paradoxical association of an early dialysis start with poor survival [J]. Kidney Int, 2010, 77(8): 700-707.
[43]
Cukor D, Rosenthal DS, Jindal RM, et al. Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients [J]. Kidney Int, 2009, 75(11): 1223-1229.
[44]
Masmoudi A, Hajjaji Darouiche M, Ben Salah H, et al. Cutaneous abnormalities in patients with end stage renal failure on chronic hemodialysis: a study of 458 patients [J]. J Dermatol Case Rep, 2014, 8(4): 86-94.
[45]
Susantitaphong P, Altamimi S, Ashkar M, et al. GFR at initiation of dialysis and mortality in CKD: a meta-analysis [J]. Am J Kidney Dis, 2012, 59(6): 829-840.
[46]
Cooper BA, Aslani A, Ryan M, et al. Nutritional state correlates with renal function at the start of dialysis [J]. Perit Dial Int, 2003, 23(3): 291-295.
[47]
Lassalle M, Labeeuw M, Frimat L, et al. Age and comorbidity may explain the paradoxical association of an early dialysis start with poor survival [J]. Kidney Int, 2010, 77(8): 700-707.
[48]
Hsu RK, Chai B, Roy JA, et al. Abrupt Decline in kidney function before initiating hemodialysis and all-cause mortality: the chronic renal insufficiency cohort (CRIC) study [J]. Am J Kidney Dis, 2016, 68(2): 193-202.
[49]
Sharief S, Hsu CY. The transition from the pre-ESRD to ESRD phase of CKD: much remains to be learned [J]. Am J Kidney Dis, 2017, 69(1): 8-10.
[50]
O′Hare AM, Wong SP, Yu MK, et al. Trends in the timing and clinical context of maintenance dialysis initiation [J]. J Am Soc Nephrol, 2015, 26(8): 1975-1981.
[51]
Ku E, Glidden DV, Johansen KL, et al. Association between strict blood pressure control during chronic kidney disease and lower mortality after onset of end-stage renal disease [J]. Kidney Int, 2015, 87(5): 1055-1060.
[52]
Cozzolino M, Ureña-Torres P, Vervloet MG, et al. Is chronic kidney disease-mineral bone disorder (CKD-MBD) really a syndrome? [J]. Nephrol Dial Transplant, 2014, 29(10): 1815-1820.
[53]
Savica V,Calo LA,Monardo P,et al. Phosphate binders and management of hyperphosphataemia in end-stage renal disease [J]. Nephrol Dial Transplant, 2006,21(8): 2065-2068.
[54]
Ersoy FF. Osteoporosis in the elderly with chronic kidney disease [J]. Int Urol Nephrol, 2007, 39(1): 321-331.
[55]
Mehrotra R, Supasyndh O, Berman N, et al. Age-related decline in serum parathyroid hormone in maintenance hemodialysis patients is independent of inflammation and dietary nutrient intake [J]. J Ren Nutr, 2004, 14(3): 134-142.
[56]
卜雄军. 老年血液透析患者甲状旁腺功能变化及其影响因素[J].中国老年学杂志,2016,7(36):3538-3539.
[57]
Lu JR, Yi Y, Tian J, et al. Prevalence and determinants of parathyroid dysfunction in elderly patients on hemodialysis [J]. Blood Purif, 2014, 37(2): 119-124.
[58]
姜文芝,张九峰.维持性血液透析致低转运性肾性骨病的诊疗进展[J].临床误诊误治,2016,29(7):113-116.
[59]
Lertdumrongluk P, Rhee CM, Park J, et al. Association of serum phosphorus concentration with mortality in elderly and nonelderly hemodialysis patients [J]. J Ren Nutr, 2013, 23(6): 411-421.
[60]
Beberashvili I, Sinuani I, Azar A, et al. Serum uric acid as a clinically useful nutritional marker and predictor of outcome in maintenance hemodialysis patients [J]. Nutrition, 2015, 31(1): 138-147.
[61]
Beberashvili I, Erlich A, Azar A, et al. Longitudinal study of serum uric acid, nutritional status, and mortality in maintenance hemodialysis patients [J]. Clin J Am Soc Nephrol, 2016, 11(6): 1015-1023.
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