| Objective:By analyzing the clinical features and prognosis of patients with CAPD in different age groups,in order to provide clinical reference basis and guide treatment,and improve the quality of life of patients with end-stage renal disease(ESRD).Methods:A total of 381 ESRD patients who were first treated with CAPD in the second Hospital of Jilin University from January 2013 to October 2019 were selected.According to the initial dialysis age and the age classification criteria of the World Health Organization,they were divided into three groups:134 patients in the young group(18-44 years old),127 patients in the middle-aged group(45-59 years old)and 120 patients in the elderly group(≥ 60 years old).Statistics included the general situation of patients,clinical indicators before and after dialysis,peritoneal transport function,number of hospitalization and causes of hospitalization,prognosis,and analyzed the clinical characteristics and prognostic factors of CAPD patients of different ages.Results:1.Overall situation: a total of 381 patients who met the inclusion and exclusion criteria were included in this study,with an average age of(50.45 ±13.46)years old.Among them,there were 134 cases(35.2%)in the young group,with an average age of(35.48 ±6.27)years old,127 cases(33.3%)in the middle-aged group,the average age was(52.02 ±3.86)years old,and 120 cases(31.5%)in the old group,the average age was(65.51 ±5.93)years old.The primary diseases were 122 cases of chronic glomerulonephritis(32.0%),119 cases of diabetic nephropathy(31.2%),93 cases of other causes(24.4%),35 cases of hypertensive renal damage(9.2%)and 12 cases of chronic interstitial glomerulonephritis(3.1%).2.Baseline data:(1)General data: there was no significant difference in gender,body mass index(BMI)and mean arterial pressure(MAP)among the three groups(P>0.05).(2)Primary disease: compared with the young group,the proportion of diabetic nephropathy in the middle-aged group and the elderly group was higher,while the proportion of chronic glomerulonephritis in the elderly group was lower(P < 0.05).(3)Peritoneal dialysis related data: compared with the young group,the 24-hour urine volume in the old group was lower(P < 0.05).The proportion of low transport and low average transport in the elderly group was lower than that in the young group and the middle-aged group(P < 0.05),while the proportion of high transport and high average transport was higher(P < 0.05).There was no significant difference in transport function between the young group and the middle-aged group(P > 0.05).(4)Laboratory indexes: compared with the young group,the middleaged group had higher levels of blood glucose,lower levels of homocysteine(Hcy),albumin(ALB),prealbumin(PAB)and serum creatinine(Scr)(P<0.05).The elderly group had higher levels of blood glucose,serum calcium(Ca)and hypersensitive C-reactive protein(Hs-CRP),and lower levels of Hcy,ALB,PAB,Scr and blood urea nitrogen(BUN),uric acid(UA),Kalium(K),phosphorus(P),parathyroid hormone(PTH)and serum iron(P<0.05).Compared with the middle-aged group,the levels of total bilirubin(TBIL),direct bilirubin(DBIL)and Hs-CRP in the elderly group were higher,while the levels of PAB,BUN,UA,Scr,K and P were lower(P<0.05).3.After one-year follow-up,the laboratory indexes:Compared with the young group,the middle-aged group had higher levels of blood glucose and ferritin,lower total protein(TP),ALB,PAB,BUN,Scr and PTH(P<0.05).The elderly group had higher levels of blood glucose and ferritin and lower levels of ALB,PAB,BUN,UA,Scr,P and PTH(P<0.05).Compared with the middle-aged group,the levels of TBIL,DBIL and indirect bilirubin(IBIL)in the elderly group were higher,and the levels of PAB,BUN,UA,Scr,P and PTH were lower in the elderly group(P<0.05).4.Hospitalization: as of the follow-up date,a total of 543 hospitalizations occurred in three age groups,mainly due to peritonitis and inadequate dialysis.the hospitalization rate of peritonitis in the elderly group was higher than that in the young group(P < 0.05).5.Outcome: as of the date of follow-up,there were 217 patients with PD,56 patients with hemodialysis,93 patients with death,13 patients with renal transplantation and 2 patients transferred out.The proportion of patients who continued PD in the elderly group was lower than that in the young group and the middle-aged group,while the death rate in the elderly group was higher than that in the young group and the middle-aged group(P < 0.05).6.Survival analysis:(1)Survival rate: the 1-year,2-year,3-year,4-year and 5-year survival rates of patients in the young group were95.4%,94.0%,88.3%,86.3% and 84.4%,respectively,and those in the middle-aged group were 90.8%,83.9%,78.2%,73.3% and67.9%,respectively.The values in the elderly group were 80.3%,70.0%,53.4%,39.0% and 29.5%,respectively.Compared with the elderly group,the survival rate was higher in middle-aged group(P=0.000)and young group(P=0.000).(2)Influencing factors: Low ALB and low 24-hour urine volume are independent risk factors affecting the prognosis of young and middle-aged patients with CAPD.Low ALB,hyperglycemia and high ferritin are independent risk factors affecting the prognosis of elderly patients with CAPD.Conclusion:1.The majority of peritoneal transport function in elderly CAPD patients was high transport and high average transport,while the majority of young and middle-aged CAPD patients were low transport and low average transport.2.More elderly patients were admitted to hospital because of peritonitis,and the proportion of elderly patients withdrawing from PD due to death was higher than that of young and middle-aged patients,and there was no significant difference in the outcome of young and middle-aged patients.3.High albumin level is a protective factor for the survival of CAPD patients.Poor residual renal function at the beginning of dialysis is an independent risk factor for the survival of young and middle-aged CAPD patients.Hyperglycemia and ferritin are independent risk factors for the survival of elderly CAPD patients. |
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