| Popis: |
The mortality rate in dialysis is very high and extreme in older patients. The 10-year survival is less than 5% in those above 60 years. We thought the stress reaction accompanying dialysis may be particularly high in the older patients with their more fragile cardiovascular system. Methods: We measured ANP and NPY levels in 33 hemodialysis patients Mean age ± SD = 60 ± 11 years, and followed them for up to 12 years (Mean ± SD = 47 ± 45 months ). We created a stress-index by adding NPY × 3 to ANP levels. Results: Stress index Mean ± SD = 275 ± 152 ng/L. 18 patients died. In Cox proportional hazard analyses, the stress index was highly predictive of death, those with an index below mean had a RR of death of only 0.221, (CI. 0.076 + 0.664, p = 0.006) when compared to those with an index above mean. In stepwise analysis, the index was the only factor necessary to predict survival when run with 17 other variables. The stress index was correlated to age, Stress index = age × 5.3 + 43, ( p = 0.026). Patients above age 60 years had a stress index of 317 ± 143 compared to 218 ± 149 below age 60 (p = 0.063).. 50% of the old patients with a high stress index were dead at 22 months compared to 101 months for those with a low index. Att six years all patients above age 60 years and with a high stress index had died compared to 40% of those with a low index p = 0.025. Conclusion: Stress reaction to dialysis is the most important variable predicting death and is particularly high in the old. Present hemodialysis regimens are very stressful and unsuitable for many older patients and should be changed to daily, slow and longer treatment. |
Plný text