One of the important medical problems in Korea ahead of the super-aged society is dialysis treatment for kidney disease patients. Although kidney disease has a high prevalence among the elderly, there are no adequate guidelines for treatment.
If kidney (kidney) damage persists for more than 3 months or continues to decline, ‘chronic kidney disease’ occurs. The incidence increases with age, with a prevalence rate of 16% among those over 70 years of age. In addition, the majority of patients receiving dialysis for end-stage renal disease are 65 years or older. As Korea is expected to enter a super-aged society by 2025, the number of patients with chronic kidney disease among the elderly is expected to increase further, but guidelines for treatment have not yet been developed.
Accordingly, a research team from the Korea Institute of Health and Medical Research (NECA) (Professor Sung-Jun Shin of Dongguk University College of Medicine, Jae-Won Yang, Professor at Wonju University, Yonsei University, and Dong-A Park, Research Fellow of the NECA Clinical Evidence Research Team) conducted a study that might add evidence to the development of guidelines for elderly patients with chronic kidney disease. .
The research team conducted a study that observed chronic kidney disease patients over the age of 60 years: ▲Comparison of the effects of dialysis treatment and conservative treatment (21 editions) ▲Comparison of the effects of hemodialysis and peritoneal dialysis (38 editions) ▲The effect of prior planning of dialysis treatment (12) and others were meta-analyzed.
As a result of comparative analysis of dialysis treatment and conservative treatment, the survival rate at 1 year of the dialysis group was 85%, and the survival rate at 2 and 3 years was 73% and 58%, respectively. On the other hand, the 1-year survival rate of the group receiving conservative treatment was 69%, the 2-year survival rate was 43%, and the 3-year survival rate was 25%. The median survival period was 38 months in the dialysis group and 20 months in the conservative treatment group, which was shorter in the conservative treatment group and higher risk of death.
What regarding the results of comparison between peritoneal dialysis, which can be performed alone at home, and hemodialysis, which requires the help of medical staff? As a result of looking at a total of 38 observational studies, the survival rate of the hemodialysis group at 3 and 5 years of dialysis was rather high. Survival time was also longer. However, there were significant differences between the literatures regarding the risk of death.
The former showed a significantly lower risk of death than the latter in the group who had planned and received dialysis treatment in advance and the group who suddenly started receiving dialysis treatment without a plan. Unplanned dialysis refers to cases where an inpatient or emergency room visit starts receiving dialysis or a central venous catheter (a tube inserted into a thick vein) is needed for urgent dialysis. The research team explained that in order to increase the survival rate of kidney disease patients, it seems to be important to start treatment with a plan in advance rather than suddenly receiving dialysis treatment without a plan.
In summarizing the above, the research team found that dialysis treatment had a greater survival benefit than conservative treatment in elderly patients with chronic kidney disease. Although hemodialysis showed a better survival rate among peritoneal dialysis and hemodialysis, it is difficult to draw a clear conclusion due to the low level of evidence. Planned treatment was more advantageous in lowering the risk of death than unplanned dialysis treatment.
This study presented an important stepping stone for decision-making by medical personnel and patient parties in that it generated evidence to improve the survival benefit of elderly patients with chronic kidney disease in Korea.
By Moon Se-young, staff reporter [email protected]
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