Prognostic analysis of different urgent-start dialysis methods in elderly patients with end-stage renal disease / 中华老年医学杂志

ABSTRACT

Objective:To investigate whether peritoneal dialysis can replace hemodialysis as an option for urgent-start dialysis for elderly patients with end-stage renal disease who need emergency initial dialysis.Methods:This was a retrospective cohort study, with enrolment of patients ≥65 years with end-stage renal disease who started hemodialysis or peritoneal dialysis for the first time at the nephrology department of our hospital between January 1, 2013 and June 1, 2019 and were followed up regularly.All patients started dialysis within 5 days of catheterization.According to different dialysis methods, patients were divided into the urgent-start hemodialysis(USHD)group and the urgent-start peritoneal dialysis(USPD)group, and were followed up until December 31, 2019.Short-term(30 days after the procedure)dialysis-related complications and survival were compared between the two groups.Results:A total of 89 elderly patients with end-stage renal disease receiving urgent-start dialysis were included, with 40 cases in the USPD group and 49 cases in the USHD group.There was no significant difference in the incidences of infection-related complications(0.0% vs.2.5%), non-infection-related complications(2.0% vs.2.5%), re-catheterization(0 vs.0)and bacteremia(0 vs.0)between the two groups( P> 0.05). The Kaplan-Meier survival curve showed that the median survival times of patients with USHD and with USPD were 63.0 months and 38.0 months, respectively, with no statistical significance(Log Rank, χ2=0.025, P=0.88). The Charlson comorbidity index( HR 1.205, 95% CI 1.026-1.415, P=0.023)and albumin level( HR 0.949, 95% CI 0.903-0.997, P=0.037)were independent risk factors for the survival and prognosis of elderly patients with urgent-start dialysis.Furthermore, we stratified and made an interactive analysis of the albumin level and the comorbidity index of elderly patients with urgent-start dialysis and found that there was no significant difference between the two modes of dialysis in the survival rate of elderly patients with end-stage renal disease( P>0.05). Conclusions:It is safe and effective to start dialysis within 5 days after peritoneal dialysis catheterization.For elderly patients with end-stage renal disease, peritoneal dialysis can replace hemodialysis as an option for urgent-start dialysis.