Clinical evaluation of long-term hemodialysis patients surviving more than 15 years

• Published in: Journal of Japanese Society for Dialysis Therapy Vol. 26; no. 1; pp. 57 - 64
• Main Authors: Nagayama, Makoto, Kon, Tadamasa, Abe, Kenji, Ohira, Seiji, Tajima, Kuniyoshi
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society for Dialysis Therapy 1993
• ISSN: 0911-5889; 1884-6211; 1884-6211
• DOI: 10.4009/jsdt1985.26.57

Sixty-three hemodialysis cases surviving more than 15 years (Group L) were clinically evaluated. These cases were introduced to hemodialysis therapy at the age of 45.8±8.4 years, while the average age of 123 cases surviving less than 5 years (Group S) was 55.0±11.3 years. Group L was introduced to this therapy at a younger age, which most likely influenced their long survival. Among routine examinations, statistical differences were noted in BUN, S-Cr, Al-P, β2-MG, C-PTH, HS-PTH and Al between the two groups. Significantly fewer cases needed rHuEPO to maintain a. Ht of 30% in Group L. Group L was superior in self-management of salt and water to Group S, as estimated by appropriate interdialytic weight gain and CTR. Systolic blood pressure was lower and persistent hypotension of less than 100mmHg was noted in about 8% of patients in Group L. However, there was no statistical difference in the dose of hemodialysis with respect to the Kt/V of the two groups, and there was no underialysis at the present time in Group L, eventhough it showed hypotensive tendency. Loss of lean body mass, as estimated from the “standard body weight” obtained by Broca's equation, was particularly prominent in males in Group L, and the annual decrease in dry weight in individual cases in Group L suggested that they had undergone chronic wasting. Parathyroidectomy for secondary HPT, surgical dissection of the carpal ligament for CTS and nephrectomy for ACDK associated with malignacy were all more frequently carried out in Group L. Progressive bone and joint damage requiring analgesics occurred in 47% of Group S but 81% of Group L, although hospitalization for this was still rare. This problem is particularly common in longer-term survivors, and is definitely an urgent subject that needs to be addressed.