老年终末期肾脏病患者血液透析与腹膜透析临床特征的横断面调查OA

Objective:To compare the clinical characteristics of hemodialysis(HD)and peritoneal dialysis(PD)in elderly patients with end-stage renal disease(ESRD),and to provide a reference for individualized dialysis modality selection.Methods:A total of 279 elderly ESRD patients receiving maintenance dialysis at the First Affiliated Hospital of Shantou University Medical College and Shantou Sanyou Hemodialysis Center from October to December 2024 were enrolled.They were divided into two groups according to dialysis modality:HD group(n=151)and PD group(n=128).Clinical data and laboratory parameters were collected to evaluate differences in bone mineral metabolism,anemia,inflammation,nutrition,and electrolytes.Logistic regression and linear regression were used to analyze associated factors.Results:No significant differences were observed between the two groups in age,sex,primary disease composition,or dialysis vintage(P>0.05).Serum calcium and phosphorus levels were lower in the HD group than in the PD group(P<0.05).The simultaneous attainment rates of serum calcium,phosphorus,and intact parathyroid hormone(iPTH)targets were 14.0％and 12.0％in the HD and PD groups,respectively(P>0.05).Multivariate logistic regression showed that the risk of iPTH>300 pg/mL was lower in the HD group than in the PD group(OR=0.539,P=0.027),and dialysis vintage(OR=1.011)and serum phosphorus(OR=2.044)were independent factors associated with elevated iPTH(P<0.05).Hemoglobin level was higher in the HD group,but serum iron,ferritin,and transferrin saturation were lower than those in the PD group(P<0.05);C-reactive protein and procalcitonin were higher in the PD group(P<0.05).Albumin,prealbumin,low-density lipoprotein,and fibrinogen were higher,and activated partial thromboplastin time was longer in the HD group(P<0.05).Serum β2-microglobulin level was lower in the HD group than in the PD group[(27.0±5.4)mg/L vs.(34.4±10.3)mg/L,P<0.001],and multivariate linear regression showed that dialysis modality had a greater influence on β2-microglobulin(standardized β=-0.444)than dialysis vintage(standardized β=0.242).Conclusion:Among elderly ESRD patients,the HD group showed advantages in nutritional status,hemoglobin level,and β2-microglobulin control,with lower microinflammatory levels;the PD group showed smaller fluctuations in iron metabolism,lipid profile,and coagulation function.Clinical decisions should individualize dialysis modality selection based on the patient's anemia type,nutritional status,and inflammatory level.