在开始透析时,年龄和转诊时间的重要性
David Antoine Jaques1, Anne Dufey2, Cyrielle Alves2
1Division of Nephrology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland. david.jaques@hug.ch.
Journal of nephrology
|August 26, 2025
概括
在老年患者中,迟到转移到透析是常见的,并且与较高的死亡率和住院病例有关. 在老年人早期转诊改善了短期预后,与年轻患者相匹配.
科学领域:
- 肝脏病学
- 老年医学
- 公共卫生
背景情况:
- 在75岁以上开始透析的患者中观察到高死亡率.
- 在开始透析之前迟到转诊与不良结果有关.
- 这项研究根据年龄和转诊时间对透析患者的结果进行了评估.
研究的目的:
- 在开始透析的患者中,研究转诊时间与结果 (死亡率,住院) 之间的关联.
- 根据转诊时间,比较老年 (> 75 岁) 和年轻 (< 75 岁) 透析患者的结果.
- 确定早期转诊是否会减轻透析患者与年龄相关的风险.
主要方法:
- 在2000年至2022年期间对906名开始透析的患者进行前性队列研究.
- 主要结局: 一年内全因死亡率. 二次结果:整体死亡率和一年的住院时间.
- 迟到的转诊定义为在第一次脏病诊断后1个月内开始透析.
主要成果:
- 与年轻患者 (26%) 相比,老年患者 (> 75岁) 的推迟迟率较高 (34%).
- 在老年患者中,晚期转诊显著增加了一年死亡率 (HR 2. 30) 和整体死亡率 (HR 1.56),并增加了住院病例.
- 较年轻的患者 (< 75 岁) 无论转诊时间如何,死亡风险都相似,住院病例较少.
结论:
- 晚期转诊在老年透析患者中普遍存在,并显著增加死亡率和住院风险.
- 老年患者的早期转诊与年轻患者相比,具有有利的短期结果.
- 优化转诊时间对于开始透析的老年患者的治疗结果至关重要.
相关概念视频
01:27Dialysis
477
Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
477
01:25Hemodialysis III: Nursing Management
183
The nursing management of a patient undergoing hemodialysis includes several critical steps, starting with a thorough assessment before the procedure.Before the Hemodialysis ProcedureFirst, record the patient's vital signs—blood pressure, heart rate, respiratory rate, and temperature—to establish a baseline. This baseline is essential for detecting conditions such as hypotension that could impact the patient's response to dialysis. Document the patient's pre-dialysis weight, as this...
183
01:25Hemodialysis I: Introduction
287
Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...
287
01:20Acute Kidney Injury V: Interprofessional Care
44
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
44
01:28Chronic Kidney Disease III: Interprofessional Care
78
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
78
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
57
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
57