Читать книгу CKD-Associated Complications: Progress in the Last Half Century - Группа авторов - Страница 35

Older patients are generally susceptible to malnutrition-wasting conditions. However, the degree to which each patient exhibits these conditions varies. We investigated the heteroscedasticity of clinical indices in patients grouped by age based on data reported by the Japanese Society for Dialysis Therapy Renal Data Registry. Clinical indices relating to wasting such as creatinine, creatinine generation rate, and albumin exhibited higher heteroscedasticity in older than in younger dialysis patients [34]. Some patients look older than their actual biological age and such patients often experience worse clinical outcomes [1].

Age is the most powerful predictor of death. We demonstrated that the primary diagnosis of ESRD was not associated with survival after initiation of dialysis in older dialysis patients, but primary diagnosis did affect survival in younger patients [1]. As such, clinical intervention barely improves survival in older patients and alternative goals might be considered, such as improvement in QOL or ADL.

Heterogeneity among patients should be considered in malnutrition-wasting conditions. Dietary restriction can be considered for robust patients, but enhancing dietary intake and physical activity is important for frail older patients. Thus, in older dialysis patients, medical professionals should consider individualized strategies such as nutritional intervention and exercise training.