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Causes of initial hemodialysis and characteristics of dialysis initiation among elderly patients with diabetic nephropathy |
TU Tianqi1,2, TU Xiaowen1,LI Yanchen1, WANG Huan1, LI Juan1, and LI Wenbo1 |
1.Department of Nephrology, PLA Rocket Force Characteristic Medical Center, Beijing 100081, China; 2.China Japan Friendship School of Clinical Medicine, Department of Medicine, Peking University, Beijing 100029, China |
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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.
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Received: 28 May 2019
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[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.
|
|
|
|