| Objective:For elderly patients with end-stage renal disease(ESRD)who need dialysis treatment,which dialysis method has a better prognosis is still controversial.In addition,most of the elderly patients entering ESRD need to start urgent-start dialysis treatment,and most of them often choose hemodialysis(HD)as the initial mode of dialysis.Recent studies have shown that peritoneal dialysis(PD)can also be used as an alternative.Therefore,this study analyzed the effects of different dialysis methods on the survival and prognosis of elderly patients with ESRD,and conducted further research on elderly patients who needed urgent-start dialysis,to explore whether PD can be used as a new choice for urgent-start of dialysis.Methods:This article is a retrospective cohort study.The study subjects were ESRD patients who started HD or PD treatment for the first time in the Department of Nephrology of our hospital from January 1,2013 to June 1,2019,and were regularly dialyzed and regularly followed up.This paper is divided into two parts,in the two parts,the inclusion criteria of the study population are the same,but the exclusion criteria are different.In the first part,after screening according to the exclusion criteria,a total of 168 elderly ESRD patients were included,which were divided into HD group(n=101)and PD group(n=67),according to different dialysis methods.In the second part,after screening according to the exclusion criteria,a total of 89 elderly ESRD patients conforming to urgent-start dialysis were included.According to different dialysis methods,they were divided into the urgent-start HD group(n=49)and the urgent-start PD group(n=40).Their demographic and clinical data were collected and followed up to December 31,2019.Deaths occurred during the follow-up period as the final outcome of the observation.Kaplan-Meier method,Log-rank test and Cox regression model were used to analyze the factors affecting the survival rate and prognosis of patients,and to further compare the short-term complications of emergency dialysis patients in the two groups.Result:1.There was no significant difference in age,sex,dialysis age,body mass index,ejection fraction,complication index and primary disease between elderly HD group and elderly PD group,elderly USHD group and elderly USPD group.2.The overall elderly population :1)Kaplan-Meier survival curve showed that the survival rate of elderly patients in HD group was higher than that in PD group,and the difference was statistically significant(Log-rank test,P <0.01).2)In addition to the mode of dialysis,age ≥ 80 years old,complication index and low albumin level were also independent risk factors for death in elderly dialysis patients.3)We further stratified and interactively analyzed the above risk factors,and the results showed that dialysis mode was still valid in the stratification of age < 80 years old,albumin <35g/L,complication index <4,and primary onset of diabetic nephropathy,which were risk factors affecting the survival of elderly dialysis patients.However,it was not found in the stratification of age ≥80 years,albumin ≥35g/L,comorbidity index ≥4,and primary non-diabetic nephropathy.3.Emergency initiation of dialysis for the elderly: 1)All the patients in USPD group were treated within 5 days after catheterization,all patients in the USHD group received dialysis treatment on the day or the next day of central venous catheterization.2)Kaplan-Meier survival curve showed no statistically significant difference in survival rate between the two groups(log-rank test,P=0.88).3)Complication index and albumin level are independent risk factors affecting the survival and prognosis of elderly patients with emergency initial dialysis.4)Further analysis of age,albumin level,complication index,primary disease stratification and interaction among elderly patients with emergency initiation of dialysis showed that the two dialysis methods in each stratification had no significant difference in the survival rate of elderly patients with ESRD(P>0.05).5)In the comparison of short-term complications,there was no significant difference in the incidence of infection-related complications,non-infectious complications,tube replacement and bacteremia between the two groups(P>0.05).Conclusion:1.In the elderly ESRD patients with age < 80 years,albumin < 35g/L,complication index < 4 and primary diabetic nephropathy,the survival rate of HD treatment was significantly higher than that of PD treatment.2.For the elderly ESRD patients who needed urgent-start dialysis,there was no significant difference in the incidence of short-term complications and long-term survival between the USHD group and the USPD group.It is safe and effective to start dialysis within 5 days after PD catheterization,PD is an option for urgent-start dialysis. |
