Clinical characteristics of elderly patients on maintenance hemodialysis in Anhui Province / 中华老年医学杂志

ABSTRACT

Objective To understand the clinical characteristics of elderly patients aged 60 years and over in Anhui Province who receive maintenance hemodialysis (MHD).Methods Clinical data of MHD patients in hemodialysis centers of 26 hospitals in Anhui Province from March 31, 2014 to January 1, 2014 were collected.With non-elderly MHD patients (aged over 18 old and under 60) serving as controls, similarities and differences in the primary disease, vascular access, nutritional status, mineral and bone disorders (MBD), and other related aspects in MHD patients were compared.Results The top three original diseases for elderly patients were chronic glomerulonephritis (CGN) (32.8 ％), hypertensive nephrosclerosis (HNS) (27.7 ％) and diabetic nephropathy (DN) (26.2％).The proportion of patients with DN and HNS in the elderly was higher than in the control group (P ＜ 0.001).Vascular access types in elderly MHD patients were arteriovenous fistula (AVF) (89.4 ％), tunneled cuffed catheter (TCC) (8.9 ％), and temporary venous catheter (1.3％).The proportion of patients with AVF was lower (P＜0.001) and the proportion of patients with TCC was higher (P＜0.001) in the elderly group than in the control group.The incidence of anemia was higher in the elderly patients than in the control group (P＜0.05);the proportion of elderly patients with hemoglobin (Hb) levels was 30.3％, in which had no significant difference as compared with the control group (P ＞ 0.05).The incidence of hypoalbuminemia was 21.2％ in elderly patients, which was higher than in the control group.The proportions of elderly MHD patients with normal levels of adjusted serum calcium, serum phosphorus, and intact parathyroid hormone (iPTH) were 52.0％, 27.9％ (higher than in the control group, P＜0.001), and 47.9％, respectively, while there was no difference in adjusted serum calcium and iPTH between the two groups (P＞0.05).The treatment rates for low serum calcium,hyperphosphatemia and secondary hyperparathyroidism (SHPT) in elderly patients were 50.6％,51.6％ and 71.5％, respectively, which had no significant difference as compared with those in the control group (P＞0.05).Conclusions Elderly patients with MHD show distinct characteristics in primary diseases, vascular access types, and nutrition and MBD status, including higher proportions of HNS and DN as their primary diseases.The type of vascular access is still dominated by AVF, and the proportion of TCC is higher.The nutritional status is poor, with a lower incidence of high phosphorus and a higher incidence of low iPTH.Efforts should be made to promote compliance in elderly patients to better control MBD, improve nutritional status and increase safety and effectiveness of treatment.