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PD 匯報

PD 匯報. 2011-10-26. 比誰老得快？ 台灣勇奪世界冠軍. 國內婦女生育率屢創新低，今年一到八月出生人數只有十萬九千一百四十一人，再度改寫歷史新低紀綠。 內政部昨天公布全台百歲以上人瑞，共計一千三百九十九人，人數創下歷史新高。 經建會援引聯合國最新資料，加入台灣數據分析後發現，台灣是全球「老得最快」的國家，預計在二○五○年趕上日本，並列為全球最老的兩個國家。 經建會預測，最快四年後全國會有一半以上的人口超過四十歲，十五年後進入老年人口占總人口比率超過百分之二十的「超高齡社會」，五十年後，有一半的人超過六十歲。. 聯合報 2010.10.10.

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PD 匯報

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  1. PD匯報 2011-10-26

  2. 比誰老得快？ 台灣勇奪世界冠軍 • 國內婦女生育率屢創新低，今年一到八月出生人數只有十萬九千一百四十一人，再度改寫歷史新低紀綠。 • 內政部昨天公布全台百歲以上人瑞，共計一千三百九十九人，人數創下歷史新高。 • 經建會援引聯合國最新資料，加入台灣數據分析後發現，台灣是全球「老得最快」的國家，預計在二○五○年趕上日本，並列為全球最老的兩個國家。 • 經建會預測，最快四年後全國會有一半以上的人口超過四十歲，十五年後進入老年人口占總人口比率超過百分之二十的「超高齡社會」，五十年後，有一半的人超過六十歲。 聯合報 2010.10.10

  3. 台灣的老人化事實 • 在二○五○年，日本與台灣的老年人口（六十五歲以上）占總人口比率，都將高達百分之三十八，並列全球最老的兩個國家。但日本花了六十年時間才達到，台灣可能只花四十年時間就「達陣」。 • 經建會預測，目前平均每六名青壯年（廿五到六十四歲的勞動力）扶養一名老年人；廿年後，將快速攀高為平均每兩個青壯年扶養一名老年人，五十年後，會變成每一名青壯年扶養一名老年人。 聯合報 2010.10.10

  4. 老年人透析人數的增加是總透析人數增加的主因老年人透析人數的增加是總透析人數增加的主因 Yang et al. Nephrol Dial Transplant, 2008

  5. 老年人透析人數的增加是總透析人數增加的主因老年人透析人數的增加是總透析人數增加的主因 Yang et al. Nephrol Dial Transplant, 2008

  6. 透析老年人一半在三年內死亡(1990-1999資料) All 1995-1999 1990-1994

  7. Which modality is better to prolong the dialysis patient survival? Periteonal dialysis (PD) Hemodialysis (HD) There is always a debate No meta-analysis evidence Heterogeneity in the patients’ background

  8. A debate on comparison of mortality in CAPD and HD patients Schaubel et al. Perit Dial Int, 1998

  9. Hemodialysis versus peritoneal dialysis: A comparison of adjusted mortality rate • 10633 ESRD patients in Canada • CAPD/CCPD (n=2841) • HD (n=7792) Fenton et al. Am J Kidney Dis, 1997

  10. Relative risk of death in USA CAPD patients: Female DM patients ≥ 55 y/o 1994 ~1996 US dialysis patients 99,048 pts 85% on HD 18,110 pts 15% on PD Relative risk of death No adjustment for co-morbidity and clinical/laboratory characteristics Collins et al. Am J Kidney Dis, 1999

  11. 糖尿病是一個重要危險因子in USA CAPD patients after adjustment of CAD or CHF CAD:冠狀動脈疾病 CHF: 鬱血性心衰竭 Ganesh et al. J Am Soc Nephrol, 2003 Stack et al. Kidney Int, 2003

  12. PD is a equal or better modality in USA non-DM and young DM patients Vonesh et al. Kidney Int, 2004

  13. Canada Denmark USA DM patients: Canada: 25%, Denmark: 19%, USA: 45%

  14. A better survival in PD patients with DM in the first 2 years. Later, there is no difference in the patient survival. A prospective study in Netherlands Termorshuizen et al. J Am Soc Nephrol, 2003

  15. Comparison of hemodialysis and peritoneal dialysis survival in The Netherlands. Kidney International (2007) 71, 153–158

  16. Age and DM accounts for the most patients on dialysis in USA: 398,940 patients in1995-2000 Age>65: total: 51%; HD: 53%; PD: 36% DM: total: 45%; HD: 44%; PD: 45% Vonesh et al. Kidney Int, 2004

  17. Three important factors interacts with treatment modality • Age > 65 years old • DM • Comorbidity: 占50%透析病人死亡原因 • 冠狀動脈疾病 • 鬱血性心衰竭

  18. Improved outcome in 1998-2000 vs 1995-1997 (USA) 1.04 Vonesh et al. Kidney Int, 2004

  19. The real difference in life expectancy • Adjust median life expectancy • HD: 35.1 months • PD: 33.8 months Vonesh et al. Kidney Int, 2004

  20. Age is an important factor of mortality 年齡大於65歲  You cannot do anything to change the fact.

  21. Diabetes mellitus is an important factor of mortality DM is an essential factor for the survival of dialysis patients in western countries.

  22. Oriental diabetic patients

  23. Hemodialysis versus peritoneal dialysis in a Japanese prospective study Non-DM on PD Non-DM on HD DM on PD DM on HD Kuriyama et al. Perit Dial Int, 2007

  24. Comparable survival rate between PD and HD in Taiwan (1995-2002) PD: 2809 HD: 45820 Huang et al. Perit Dial Int, 2008

  25. 糖尿病是台灣透析病人死亡的一個重要危險因子糖尿病是台灣透析病人死亡的一個重要危險因子 Age  55 Non-DM on PD Non-DM on HD DM on HD DM on PD Huang et al. Perit Dial Int, 2008

  26. 糖尿病是台灣透析病人死亡的一個重要危險因子糖尿病是台灣透析病人死亡的一個重要危險因子 Age  55 Non-DM on HD Non-DM on PD DM on HD DM on PD Huang et al. Perit Dial Int, 2008

  27. DM is an important risk factor in Taiwanese dialysis patients Overall Non-DM 1995 ~2006 NTUH: 305 HD, 428 PD DM Kao et al. J Nephrol, 2010

  28. Comparable survival in CAPD and HD patients aged more than 65 years 1985 ~2004 Historic cohort CGMH: 548 HD, 144 PD Hung et al. Int J Clin Pract, 2009

  29. Elder PD patients with DM have a lower survival rate Age ≥ 65 y/o Non-DM DM Hung et al. Int J Clin Pract, 2009

  30. 心血管疾病是一個透析病人死亡的重要原因 透析病人心血管疾病死亡率比一般人心血管疾病死亡率高10~30倍 心血管疾病的原因: Vascular remodeling Vascular calcification

  31. Vascular remodeling • Increased tensile stress • Prevention • Intravascular volume control: Interdialytic body weight gain < 5% increase • Adequate blood pressure control

  32. Vascular calcification的原因 Nolan et al. J Am Soc Nephrol, 2010

  33. Vascular calcification的結果 • Myocardia ischemia: acute myocardia infarction and angina pectoris • Congestive heart failure • Cardiac valve insufficiency • Cardiac arrhythmia • Ischemia of peripheral vessels

  34. Prevention of vascular calcification: Adequate dialysis • Prescribed dose: Kt/V > 1.3 and delivered dose Kt/V > 1.2 in hemodialysis patients • For CAPD, the delivered PD dose should be a total Kt/Vurea of at least 2.0 per week and a total creatinine clearance (CCr) of at least 60 L/wk/1.73 m2 for high and high-average transporters, and 50 L/wk/1.73 m2 in low and low-average transporters. K-DOQI guideline, 2002

  35. Prevention of vascular calcification: Bone-mineral disease • Control of hyperparathyroidism: iPTH 150 ~ 300 pg/mL • CaxP < 55 • Corrected Ca: 8.8~9.5 mg/dL • Taking Ca-based phosphate binders < 10.2 mg/dL • P: 3.5~5.5 mg/dL K-DOQI guideline, 2002

  36. Brief summary • PD with equivalent or better survival among non-DM patients • In DM patients, younger patients may benefit from PD (age<45y/o in USA; equally in in Canada and Denmark) • PD has an equal or lower mortality rate during the first 1-2 years. • A temporal trend of improved outcome in PD that exceeds HD. • Age, DM and co-morbidity(conary artery disease and congestive heart failure) are important factors.

  37. 腎臟移植是減少透析死亡率的重要方法

  38. 腎臟移植和血液透析死亡率比較 Data from 臺灣腎移植學會

  39. 實際病人數 植管數 1987 l 1990 1991 l 1995 1996 l 2000 2001 l 2005 2006 l 2010 Growth rate of PD patients in LK-CGMH 1474 974 595 440(30%) 233 375(39%) 286(48%) 98(42%) 72 59(82%)

  40. 林口院區PD病人成長數統計

  41. 各院區成長目標

  42. 年度死亡率 %

  43. Outcome of PD peritonitis in 2010

  44. 年度住院率/百人月

  45. Kt/V年度平均值

  46. Albumin年度平均值

  47. CTR年度平均值

  48. Hct年度平均值

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