老年洗腎患者腹膜透析之預後及併發症討論

趙梓辰、游智欽

台北慈濟醫院  泌尿科

Clinical Outcomes of Peritoneal Dialysis in elder ESRD patients

Tze-Chen Chao, Chih-Chin Yu

Division of Urology, Taipei Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan

Purpose: To evaluate whether age is a risk factor of complications in elder end stage renal disease (ESRD) patients receiving peritoneal dialysis.

Materials and Methods: We conducted a retrospective study including all peritoneal dialysis cases treated from March 2016 to August 2019. Patient demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Two surgical procedures were applied. Patients who could undergo general anesthesia would receive laparoscopic approach of peritoneal dialysis catheter (PDC) implantation; the other patients would receive open method PDC implatation. Surgical complications and infectious complications were recorded. Kaplan-Meier overall and infectious catheter survival curves were analyzed.

Results: Seventy-seven patients were referred to urology department for peritoneal dialysis catheter (PDC) implantation. Forty-seven patients aged under 65, and 30 patients aged 65 and above. Median age of patients in the two groups were 56 (17 - 64) and 75 (65 - 96) respectively. More patient in aged 65 and above group received open method PDC implantation. The operative time was significantly longer in aged under 65 group, because of the fact that the laparoscopic technique carried more in aged under 65 years old. There were no significant differences in surgical complications between the two groups. No visceral injury, pericatheter leakage, and hernia were reported in our study group. Kaplan-Meier infection free survival curve and PDC survival curves showed no difference between the 2 groups.

Conclusions: Similar complication rates and survival curves were noted in our patients. With good care staff and detailed training program, we believe that peritoneal dialysis is a good renal replacement therapy for ESRD patients aged 65 and above.