关键词: 糖尿病肾病, 老年人, 肾透析, 并发症, 个体化血液透析

Abstract:

Objective To explore the effect of individualized hemodialysis on dialysis complications in elderly patients with diabetic nephropathy (DN). Methods A total of 80 elderly hemodialysis patients with end-stage renal disease (ESRD) admitted in our hospital were selected, including 40 DN patients (DN group) and 40 non-DN (NDN group). They were further divided into DN1 subgroup and DN2 subgroup, as well as NDN1 subgroup and NDN2 subgroup, with 20 cases per group. Patients in DN1 and NDN1 group were given an individualized hemodialysis, and those in DN2 and NDN2 group were given a routine hemodialysis. After the observation for 1 year, the incidence of complications like hypotension, hypoglycemia, limb spasm and hypertension was compared. The decline rate of serum albumin (ALB), hemoglobin (Hg) and blood urea nitrogen (BUN) were recorded. Results After an individualized or routine dialysis, the frequency (number of times) of hypotension (11.0 vs 3.5, 19.5 vs 9.5), hypoglycemia (5.0 vs 0.0, 11.5 vs 3.5) and limb spasms (3.0 vs 0.0, 9.5 vs 1.0) was significantly higher in DN group than those of NDN group (P<0.01). Hypertension during dialysis was only found significantly more frequent in DN2 subgroup than that of NDN2 subgroup (18.0 vs 5.5, P<0.01). Compared with those of routine dialysis in DN group and NDN group, an individualized dialysis in both groups significantly reduced the frequency (number of times) of hypotension (11.0 vs 19.5, 3.5 vs 9.5), hypoglycemia (5.0 vs 11.5, 0.0 vs 3.5) and limb spasms (3.0 vs 9.5, 0.0 vs 1.0) (P<0.05). Hypertension during dialysis was only found significantly less frequent in DN1 subgroup than that of DN2 subgroup (10.0 vs 18.0, P<0.05). After an individualized or routine dialysis, there were no significant differences in ALB (40.80±2.84 g/L vs 42.75±4.56 g/L, 42.40±4.17 g/L vs 42.65±2.92 g/L), Hg (103.50±15.37 g/L vs 109.90±9.71 g/L, 108.60±13.80 g/L vs 112.90±7.81 g/L) and urea nitrogen reduction rate (URR%) (56.10%±8.01% vs 63.95%±6.05%, 59.70%±5.28% vs 63.15%±5.86%) between DN group and NDN group (P>0.05). Compared with those of routine dialysis in DN group and NDN group, there were no significant differences in ALB (40.80±2.84 g/L vs 43.40±4.17 g/L, 42.55±4.56 g/L vs 42.65±2.92 g/L), Hg (103.50±15.37 g/L vs 108.60±13.80 g/L, 109.90±9.71 g/L vs 112.90±7.81 g/L) and URR% (56.10%±8.01% vs 59.70%±5.28%, 63.95%±6.05% vs 63.15%±5.86%)(P>0.05). Conclusion The incidence of complications during dialysis is high in elderly patients with DN. An individualized dialysis is effective in reducing the above complications without affecting the dialysis effect.

Key words: diabetic nephropathies, aged, renal dialysis, complications, individualized hemodialysis