| Obstructive: 1)To analysis the influence factors of the short-term death of the elderly undergoing maintenance hemodialysis and explore the possible ways and means of improving their long-term survival. 2) To study the influencing factors correlated with the effect of anemia management as well as the relationship between improvement of anemia and heart structure and function in elderly maintenance hemodialysis patients.Methods: 1)Retrospectively collect the information of the protopathy, predialysis nephrological care duration, outcome, dialysis sufficiency, values of blood pressure, hemoglobin, surum lipid, albumin, C-reactive protein, serum phosphorus, echocardiogram, cause of death, dialysis access and survival rate of the 193 elderly end-stage renal disease patients who received their first hemodialysis in title General Hospital of PLA between March 1987 and November 2004. Twenty-nine patients who survived less than 1 year and twenty-one who survived more than 4 years were chosen, and the influence factors of their survival were compared.2)Sixty-eight of those 193 prevously observed elderly patients kept hemodialysis till now in our hospital and were enrolled in this study. Age, blood pressure, blood routine examination, and data of color Doppler echocardiography were collected when hemodialysis duration was more than 3-4 months, and if anemia was an independent risk factor of the change of heart structure and function was studied. After treatment, according to the hemoglobin levels, the patients were divided into either anemia correctedgroup(n=30) or anemia group(n=38). The factors influencing the effect of anemia management as well as the relationship between improvement of anemia and the heart structure and function were observed.Results: 1.General condition: (l)As the data showed, 115 males and 78 females aged 66.1±5.5 years at the start of hemodialysis were included and 26.4% of them were older than 70 years. 72.5% patients had their CCr lower than 10ml/min, and 33.2% patients received predialysis nephrological care duration less than 3 months. (2)The most popular disease causing ESRD was ischemic renal injury(23.8%) in this cohort, followed by primary glomerulonephritis(22.8%), drug-associated renal disease(17.6%) and diabetic nephropathy(16.6%). (3)The value of KT/V, URR and TACurea was 1.29±0.16, 0.66±0.04 and (48,64±12.54)mg/dl. (4)74.6% patients underwent hypertension. (5)98.4% patients were found anemic and 81.9% were moderate or severe anemic. (6)33.7% patients were found hypertriglyceridemia. (7)The value of PCR was (1.02±0.25g)/Kg/d and 40.9% patients had their serum albumin lower than 35g/L. (8)71.9% of 172 patients were found ESR higher than 20mm/h and 37.1% of 175 patients had their CRP higher than 0.8mg/dl. (9)Hyperphosphataemia was found in 61.7% patients and 49 of 151 patients were found hyperparathyroidism. (10)4 patients who underwent hemodialysis for more than 10 years suffered dialysis-related amylodosis. (11)Eighty-four of 121 patients underwent LVH. (12)41.5% patients used AV fistula as their blood access at the start of hemodialysis. (13)As the complications of nemia, inflammation, hypertension, LVH, abnormity of calcium-phosphorus metabolism, dyslipidemia and malnutrition were concerned, 60.6% patients suffered at least 4 types of the complications.2.Outcomes and death influencing factors: (1)35.2% patients underwent hemodialysis till November 2004, 10.9% had transplantation surgery, 2.6% turned to CAPD, 23.8% transferred to other hospitals forhemodialysis and 27.5% died. (2)The 1-year, 5-year and 10-year survival rate of these patients was 82.2%, 51.3% and 24.6%. (3)The cardiovascular disease and infection were the main causes of death. (4)Multi-variant Logistic analysis showed that albumin, CRP, hemoglobin, triglyceride, predialysis nephrological care duration and age at the start of hemodialysis were factors influencing hemodialysis patients' survival(p<0.001).3. Factors influencing anemia management effects and the relationship between anemia improvement and cardiac function: (l)As multi-variant Logistic analysis showed, albumin, CRP, serum iron and triglyceride were the factors influencing anemia manaigement effects. (2)68 of those 193 previously observed patients who kept hemodialysis were followed up, and 30 patients' hemoglobin were more than 110g/L(anemia corrected group), while 38 patients' hemoglobin were: less than that(anemia group). The cardiac function improved more significantly in anemia corrected group than that in anemia group (LVMI 133. 7 + 22. 3g/m2 VS 156.6±24.5g/m2,EF 65.0±6.4% VS 60.6±4.7%, p<0.05). In anemia corrected group, the cardiac function was improved significantly (LVMI 157. 1+36. 9g/m2 VS 133. 7 + 22. 3g/m2, EF 61.5 + 6.4% VS 65.0 + 6.4%, p<0. 05). Yet in anemia group, the improvement of the cardiac function was not significant(p>0.05). Conclusion: (l)As it showed, males were more than females and 26.4% patients were older than 70 years. Ischemic renal injury and chronic glomerulonephritis were the main primary disease of ESRD in elderly. (2)The elderly hemodialysis patients suffered such complications as anemia, hypertension, LVH, hyperphosphataemia, malnutrition, infection and dyslipidemia. 52.3% patients suffered more than 4 kinds of those complications. (3) The cardiovascular disease and infection were the main causes of death. (4)Malnutrition, inflammation, anemia, dyslipidemia seemed to be the most important risk factors of the death, while early predialysis nephrological care and age at the start of hemodialysis might be... |
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