ABSTRACT
BACKGROUND: According to the trend of global population aging, the proportion of elderly patients with chronic kidney disease (CKD) is expected to increase. However, there are more than 20 million people in China with decompensated kidney function, of which 19.25% are elderly people. Therefore, special attention should be paid to the education years, sleep quality, anxiety status, comorbidities with diabetes, cardiovascular disease (CVD), and anemia as independent risk factors for depression in elderly CKD patients. This study explores the clinical mana-gement of elderly CKD patients that should address these risk factors to prevent depression and improve their prognosis. AIM: To investigate depression risk factors in older patients receiving peritoneal dialysis, aiding future prevention of depression in these patients. METHODS: This retrospective study included a primary study population of 170 patients with CKD who received peritoneal dialysis from January 2020 to December 2022. We assessed the patients' mental status using the Beck Depression Inventory Score-II (BDI-II), Self-Rating Anxiety Scale (SAS), Anxiety Inventory Score, and the Pittsburgh Sleep Quality Index (PSQI). Logistic regression was employed to identify depression independent risk factors among these patients. RESULTS: The non-depressed group had a significantly longer education period than the depressed group (P < 0.05). The depressed group exhibited significantly higher mental status scores than the non-depressed group (P < 0.001). Patients with diabetes mellitus (DM) or CVD had a higher probability of developing dep-ression. Patients with depression had significantly lower hemoglobin and albumin levels than patients without depression (P < 0.05). Spearman correlation analysis of BDI-II scale scores, measuring depression, indicated positive correlations with BDI-II and SAS scores as risk factors for depression in patients with CKD. In contrast, years of education, hemoglobin levels, and peritoneal Kt/V were negatively correlated, serving as protective factors against depression. An analysis of variance for influences with significant differences in the univariate analysis revealed that years of schooling, BDI-II, SAS, PSQI, DM, CVD, and hemoglobin levels independently influenced depression in older patients with CKD. CONCLUSION: Education, BDI-II, SAS, PSQI, DM, and CVD are independent risk factors for depression in older patients with CKD; therefore, post-treatment psychological monitoring of high-risk patients is crucial to prevent depression.
ABSTRACT
BACKGROUND: Diabetic nephropathy (DN) is frequently seen in the development of diabetes mellitus, and its pathogenic factors are complicated. Its current treatment is controversial, and there is a lack of a relevant efficacy prediction model. AIM: To determine the effects of paricalcitol combined with hemodiafiltration on bone-metabolism-related indexes in patients with DN and chronic renal failure (CRF), and to construct an efficacy prediction model. METHODS: We retrospectively analyzed 422 patients with DN and CRF treated in Cangzhou Central Hospital between May 2020 and May 2022. We selected 94 patients who met the inclusion and exclusion criteria. Patients were assigned to a dialysis group (n = 45) and a joint group (n = 49) in relation to therapeutic regimen. The clinical efficacy of the two groups was compared after treatment. The changes in laboratory indexes after treatment were evaluated, and the two groups were compared for the incidence of adverse reactions. The predictive value of laboratory indexes on the clinical efficacy on patients was analyzed. RESULTS: The dialysis group showed a notably worse improvement in clinical efficacy than the joint group (P = 0.017). After treatment, the joint group showed notably lower serum levels of serum creatinine, uric acid (UA) and blood urea nitrogen (BUN) than the dialysis group (P < 0.05). After treatment, the joint group had lower serum levels of phosphorus, procollagen type I amino-terminal propeptide (PINP) and intact parathyroid hormone than the dialysis group, but a higher calcium level (P < 0.001). Both groups had a similar incidence of adverse reactions (P > 0.05). According to least absolute shrinkage and selection operator regression analysis, UA, BUN, phosphorus and PINP were related to treatment efficacy. According to further comparison, the non-improvement group had higher risk scores than the improvement group (P < 0.0001), and the area under the curve of the risk score in efficacy prediction was 0.945. CONCLUSION: For treatment of CRF and DN, combined paricalcitol and hemodiafiltration can deliver higher clinical efficacy and improve the bone metabolism of patients, with good safety.
ABSTRACT
BACKGROUND: Peritoneal dialysis (PD) is the main renal replacement therapy in elderly patients account for hemodynamic stability. The clinical characteristics and prognosis of elderly PD patients are varies in different dialysis centers. We analyzed the characteristics, outcomes and prognosis factors of survival in elderly PD patients in China, to better understand their status and improve their quality of life. METHODS: This prospective, observational study categorized 202 PD patients by age: elderly group ≥65 years, younger group <65 years. The inclusion criteria were: age >18 years, first PD treatment and dialysis time >3 months, and complete data. Clinical characteristics including demographic data, hemodynamic variables were compared between groups. After a median follow-up of 44 months, prognosis outcomes between young and elderly groups were measured. Multivariate Cox regression analysis were used to establish the models for predicting outcomes. Then the nomogram of the model was generated. RESULTS: A total of 202 PD patients were enrolled: 61 in the elderly group and 141 in the younger group. The comparison of baseline data revealed decreased serum albumin, normalized protein catabolic rate and higher incidence of previous cardiovascular, cerebrovascular diseases, Charlson Comorbidity Index (CCI) in the elderly group. The mortality rate was substantially higher in the elderly group. Cardiovascular disease was the main cause of death in elderly PD patients. High body mass index (BMI) [hazard ratio (HR) =1.0, 95% confidence interval (CI): 1.0-1.1, P=0.005], high CCI (HR =1.1, 95% CI: 1.0-1.2, P=0.022), and ischemic heart disease (ISD) (HR =2.5, 95% CI: 1.0-6.1, P=0.042) were risk factors for the long-term survival of elderly PD patients. CONCLUSIONS: High BMI, high CCI and ISD were important factors for evaluating the adverse outcomes of elderly PD patients. Larger studied are needed to identify risk factors in elderly PD patients and to improve their outcomes.