影響老年新透析病患早期6個月內死亡之因素分析

研究目的：本研究目的主要在探討大於等於65歲以上新透析病患於6個月內死亡的危險因子。研究方法及材料：本研究個案收集來自某醫療連鎖機構之透析病患資料庫，取樣期間為2003年1月至2013年12月止，篩選65歲以上開始接受血液透析的病患，總計收集老年血液透析病患3422人，為瞭解影響老年透析病患早期死亡之危險因子，將研究個案分為“透析6個月內死亡病患”及“透析超過6個月以上的病患”兩組，採用t-test、Chi-Square test、Yates’ correlation χ2 test、Fisher Exact test等統計分析法，逐一比較兩組病患之性別、透析年齡、原發病、透析初期合併症、生活功能評估、透析通路及藥劑使用、透析品質檢驗、生化與血液檢驗等各變項之差異性，並採用多元逐步邏輯斯迴歸分析，以篩選出對老年透析病患早期死亡的重要影響的危險因子變項。研究結果：本研究總計收集老年血液透析病患3422人，其中於透析6個月內死亡的病患計有133人（3.9%），而透析超過6個月以上的病患計有3289人。本研究結果指出：老年透析病患的年齡、原發病、合併症（糖尿症、高血壓、鬱血性心衰竭）、生活功能評估（生活活動與一般生活）、血液通路（自體動靜脈廔管、其他長期導管、其他短期導管）、藥劑使用（活性維他命D、鐵劑）、透析品質檢驗（透析前體重、透析後體重、透析後BUN、URR、Kt/V (Gotch)）、生化血液檢驗（Albumin、A.S.T.[GOT]、Hbc、Hct、Uric acid、P）等變項與老年透析病患早期死亡有顯著相關，經多元逐步邏輯斯迴歸分析結果，選入邏輯斯迴歸模式的顯著變項，依序為：生活活動評估、Hct、血液通路、Albumin等四項，此四個重要危險影響變項可解釋老年透析病患早期死亡的總變異量，依Cox & Snell R2達6.1%，依Nagelkerke R2達29%，此迴歸模式預測正確率達97.6%。結論與建議: 初次透析的老年病患6個月內死亡率為3.9%，經多元逐步邏輯斯迴歸分析，生活活動評估、Hct、Albumin、透析通路等四項為老年新透析病患開始透析後6個月內死亡的重要影響因子。本研究結果可以提供國內對於老年新透析病患是否需要接受透析治療的參考指標。

Objective：The main purpose of this study is to explore the risk factors for 6-month mortality in elderly patients starting dialysis for end-stage renal disease Mthods and Materials：We included patients from a dialysis provider renal data sytem who initiated dialysis from January 1,2003 to December 31, 2013, were ≧65 years old(n=3422). The cohort were divided into “die within 6 months” and “survive over 6 months” two groups. T-test、Chi-Square test、Yates’correlationχ2 test、Fisher Exact test were used to compare variables such as gender, age, primary disease, cormobitidy,functional status scale, dialysis access, dialysis- related drugs used, dialysis quality test, laboratory data. Risk factors for early 6-month mortality were determined by multivariate logistic regression method. Results：In total, 133(3.9%) of 3422 patients died during first 6 months on dialysis. Age, primary disease (Diabetes, hypertension, congestive heart failure), functional status scale, Vascular access, dialysis-related drugs( Vitamin D and iron), dialysis quality test( Pre and post dialysis weight, post dialysis BUN, URR, KT/V(Gotch)), laboratory data（Albumin、A.S.T.[GOT]、Hbc、Hct、Uric acid、P）had significant correlation with 6-month early mortality. The result of multivariable logistic regression indicated the highest risk factor for early 6-month mortality was low functional status scale (Karnofsky scale), followed by Hct, vascular access, and albumin.The accurate predictive rate of regression model was 97.6%. Conclusion and Suggestion：The 6-month mortality rate in incident aged(≧65) hemodialysis patients was 3.9%. Function status scale, Hct, vascular access and albumin were the strong risk factors for early 6-month mortality. It is hoped that these results can provide medical worker’s a guideline for evaluating the prognosis of aged patients who were receiving their first hemodialysis treatment and further help patients and their family in planning succeeding care in advance.