The Clinical Study Of Maintenance Hemodialysis And Its Vascular Access In The Elderly

Objective:Through the analysis of the age,sex,primary disease,dialysis-related complications and causes of death in 306 patients with maintenance hemodialysis,the status of maintenance hemodialysis was analyzed,and data were provided to improve the quality of dialysis.Methods:Study the design of a unified questionnaire,the investigators conducted a unified training to collect January 2012-January 2017 during the Nanjing Medical University First Affiliated Hospital,Nanjing Qixia Hospital,Qingdao City,the Eighth People's Hospital three hemodialysis center maintenance of blood The clinical data of 306 patients in dialysis patients included age,sex,educational experience,primary disease,comorbidities,causes of death,peripheral veins through peripheral cannula,PICC or pacemaker,etc.History,history of smoking,as well as laboratory indicators such as hemoglobin,serum calcium(by albumin correction),phosphorus,all parathyroid hormone,albumin and so on.And grouped by age,and further analysis of the characteristics of elderly patients with maintenance hemodialysis.Results:Gender and age:217 male,89 female.Age:The average age was 61.93 ±16.44 years old,average age of male was 62.12±16.57 years old(24-92 years old),and average age of women was 61.45±16.21 years old(27-100 years old).According to the age group,the elderly group(65-100 years)134 people,non-elderly group(24-64 years old)172 people.Etiology of renal failure:96 chronic glomerulonephritis(31.4%)as the first,followed by 81 diabetic nephropathy(26.5%).Causes of death:47 cases of death in the elderly group,the causes of death are as follows:18 cases of cardiovascular and cerebrovascular diseases(38.3%),infection in 16 cases(34%),the other 9 cases(19.1%),unknown 4 cases(8.5%).Dialysis-related complications:the elderly group,the average hemoglobin value of was 105.28±15.97 g/L and the compliance rate was 25.3%(P<0.001).The mean level of serum calcium in the elderly group was 2.0±0.17 mmol/L and the compliance rate was 50.7%.The average level of blood phosphorus in the elderly group was 1.6±0.67mmol/L and the compliance rate was 40.3%(P<0.001).The average PTH level in the elderly group was 295.95 ±342.75 pg/mL and the compliance rate was 41%(P<0.05).Complications:6 cases of malignant tumors(2.0%),98 patients with diabetes(32%),combined with peripheral vascular disease in 5 cases(1.6%),combined with cerebrovascular disease in 64 cases(20.9%),combined Coronary atherosclerotic heart disease in 86 cases(28.1%).Conclusion:1,elderly patients with MHD complicated with coronary heart disease,cerebrovascular disease and a high proportion of diabetes.2,elderly patients with MHD combined with a high proportion of malnutrition.3,elderly patients with MHD than non-elderly,in a high rate of inflammation in the state 4,elderly patients with MHD and PTH compliance is better than non-elderly group,compared with patients with foreign countries,blood phosphorus compliance rate is low and the difference was statistically significant.5,cardiovascular disease and infection is the main cause of death in elderly patients with MHD.Objective:Choosing an optimal vascular access for the elderly is an difficult problem,the distal arteriovenous fistula generally is the preferred vascular access in the most hemodialysis initiation patients,however,some authors report inferior patency rates of distal arteriovenous fistulas in elderly patients.A meta-analysis in these reported studies were presented to compare the outcomes of different hemodialysis vascular access in elderly patients.Methods:A literature search was performed using the PubMed and Embase databases.The studies which comprised patency of various vascular accesses in elderly patients and compared with those results in non-elderly patients were analyzed.Besides,the articles those comparing patency rates of radial-cephalic and brachio-cephalic elbow fistulas or prosthetic grafts in elderly patients were also included.Results:The meta-analysis showed the higher failure rate of radial-cephalic arteriovenous fistula in elderly patients compared with non-elderly adults at 12(odds ratio[OR],1.30,P=0.01)and 24 months(OR,1.06,P=0.63).The primary patency of radial-cephalic arteriovenous fistula was also higher in the non-elderly adults(OR,1.61;P=0.01).Secondary analysis showed that the patency of elbow brachio-cephalic fistulas was aslo higher compared with distal fistulas in elderly patients(P=0.0006),and the diabetic patients had the higher risk of failure in radial-cephalic fistulas at 12 months compared to non-diabetic patients.(OR,1.63;95%Cl,1.07 to 2.47,P=0.02)Conclusion:Our study found an increased rate of radial-cephalic fistula failure in the elderly patients and high patency in the creation of elbow brachio-cephalic fistulas.Moreover,the diabetes mellitus would increase the risk of radial-cephalic fistula failure.When choosing the vascular access for the elderly patients,these should be mindful considerations.Objective:The aim of this study was to investigate the status of vascular access in elderly patients with maintenance hemodialysis,and to analyze the possible factors that influence the maturity of autologous arteriovenous fistula.Methods:A total of 306 patients with maintenance hemodialysis were enrolled in the First Affiliated Hospital of Nanjing Medical University,Qixia Hospital and Qingdao Eighth People's Hospital from January 2012 to January 2017.The types of blood vessel access were collected.And the symptoms of maturation or failure,preoperative ultrasound measurement of blood vessels and perioperative blood pressure,hemoglobin,total cholesterol,serum calcium,phosphorus,PTH indicators.Results:The first dialysis using fistula and maintenance dialysis using fistula were 50.3%and 90.5%,respectively,to meet and exceed the KDOQI guidelines recommended.The elderly wrist fistula and non-elderly wrist fistula group,the elderly elbow fistula group and non-elderly elbow fistula group,as well as the elderly wrist fistula and elbow fistula immediately fistula failure,early loss of power,(P>0.05),but there was no significant difference between the two groups(P>0.05).The power loss rate of the wrist fistula was higher than that of the non-elderly people.(<28 days)and the blood flow of radial artery(<20ml/min)were the factors influencing the maturation of fistula in elderly patients with MHD(P<0.05)Conclusion:The duration between surgery to puncture less than 28 days and radial arterial blood flow less than 20ml/min were the factors that influenced the maturation of the fistula in elderly MHD patients.The patients with CKD4 stage should be completely evaluated and the fistula should be made in advance.