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Original article

Vol. 144 No. 0708 (2014)

Outcome of dialysis patients aged seventy years or above – a retrospective analysis

  • Letizia F. Scholl
  • Michael Dickenmann
  • Patricia Hirt-Minkowski
DOI
https://doi.org/10.4414/smw.2014.13920
Cite this as:
Swiss Med Wkly. 2014;144:w13920
Published
09.02.2014

Summary

OBJECTIVE: Due to increased life expectancy, there is a growing number of older patients with end-stage renal disease (ESRD) requiring renal replacement therapy (RRT). However, there is a lack of data with regard to clinical outcomes of these patients.

METHODS: In this single-centre study, we retrospectively analysed two groups of patients on chronic haemodialysis, stratified by age. A group of patients ≥70 years of age (“seniors”; n = 69) was compared with a control group of patients 60 to 69 years of age (“elderly”; n = 39). The major outcomes that we investigated were: patient survival, causes of death, and type and frequency of complications.

RESULTS: Kaplan-Meier curves revealed only a trend towards better survival in the elderly (p = 0.06). During the observation time, about half of the patients died: 38/69 in the senior group and 14/39 in the elderly group (p = 0.07). The cause of death was mostly unknown. Both groups were affected equally by complications during haemodialysis therapy (p = 0.62). For the severity of complications, the only significant difference was a higher frequency of complications with outpatient treatment in seniors (p = 0.04). However, there were not more severe complications leading to hospitalisation in seniors (p = 0.64).

CONCLUSION: Age is not a good predictor for the outcome of patients of 70 years of age or older with ESRD requiring RRT and thus age alone should never guide us in the decision-making process as to whether to start dialysis or not in these patients.

References

  1. Van de Luijtgaarden M, Noordzij M, Wanner C, Jager K. Renal replacement therapy in Europe – a summary of the 2009 ERA–EDTA Registry Annual Report. Clin Kidney J. 2012;5:109–19.
  2. Fresenius Medical Care Deutschland GmbH. “ESRD Patients in 2011. A Global Perspective”. 2012 [cited 2013 5th March]; Available from: http://www.vision-fmc.com/files/download/ESRD/ESRD_Patients_in_2011.pdf
  3. U S Renal Data System, USRDS 2012 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2012. Chapter 1, Figure 12.B, Volume 2.
  4. U S Renal Data System, USRDS 2012 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2012. Chapter A, Table A.1, Volume 2.
  5. Stel VS, Kramer A, Zoccali C, Jager KJ. The 2006 ERA-EDTA Registry annual report: a précis. J Nephrol. 2009;22:1–12.
  6. Couchoud C, Labeeuw M, Moranne O, Allot V, Esnault V, Frimat L, et al. A clinical score to predict 6–month prognosis in elderly patients starting dialysis for end-stage renal disease. Nephrol Dial Transplant. 2009;24(5):1553–61.
  7. Burkhalter F, Steiger J, Dickenmann M. A road map for patients with imminent end-stage renal disease. Swiss Med Wkly. 2012;142:w13713
  8. Raine AEG. The susceptible patient. Nephrol Dial Transplant. 1996;11(Suppl 2):6–10.
  9. Palmer BF, Henrich WL. Recent advances in the prevention and management of intradialytic hypotension. J Am Soc Nephrol. 2008;19:8–11.
  10. Desmet C, Beguin C, Swine C, Jadoul M; Université Catholique de Louvain Collaborative Group. Falls in hemodialysis patients: prospective study of incidence, risk factors, and complications. Am J Kidney Dis. 2005;45(1):148–53.
  11. Callahan D. Setting Limits: Medical Goals in an Aging Society. Simon & Schuster. New York; 1987.
  12. Moss AH, Stocking CB, Sachs GA, Siegler M. Variations in the attitudes of dialysis unit medical directors towards decisions to withhold and withdraw dialysis. J Am Soc Nephrol. 1993;4:229–34.
  13. Holley JL. Foulks CJ, Moss AH. Nephrologists’ reported attitudes about factors influencing recommendations to initiate or withdraw dialysis. J Am Soc Nephrol. 1991;1:1284–21.
  14. Ismail N. Renal replacement therapy in the elderly: an old problem with young solutions. Nephrol Dial Transplant. 1997;12(5):873–76.
  15. Ismail N. Hakim RM, Oreopoulos DG, Patrikarea A. Renal replacement therapy in the elderly: Part 1. Hemodialysis and chronic peritoneal dialysis. Am J Kidney Dis. 1993;22(6):759–82.
  16. Breidthardt T, Moser-Bucher CN, Praehauser C, Garzoni D, Bächler K, Steiger J, et al. Swiss Med Wkly. 2011;141:w13150
  17. Letourneau I, Ouimet D, Dumont M, Pichette V, Leblanc M. Renal replacement in end-stage renal disease patients over 75 years old. Am J Nephrol. 2003;23:71–7.
  18. Munshi SK, Vijayakumar N, Taub NA, Bhullar H, Lo TC, Warwick G. Outcome of renal replacement therapy in the very elderly. Nephrol Dial Transplant. 2001;16(1):128–33.
  19. Glaudet F, Hottelart C, Allrad J, Allot V, Bocquentin F, Boudet R et al. BMC Nephrology. 2013;14:131(25 June 2013)
  20. Schweizerische Eidgenossenschaft Federal Statistical Office, Neuchâtel 2013. Life expectancy. [cited 2013 5th March]. Available from: http://www.bfs.admin.ch/bfs/portal/en/index/themen/01/06/blank/key/04/04.html
  21. The World Bank. Public data Lebenserwartung Vereinigte Staaten 2010. [cited 2013 5th March]. Available on: http://www.google.ch/publicdata/explore
  22. Schwenger V, Morath C, Hofmann A, Hoffmann O, Zeier M, Ritz E. Late referral – a major cause of poor outcome in the very elderly dialysis patient. Nephrol Dial Transplant. 2006;21(4):962–67.
  23. Isles C, Robertson S, Almond A, Donaldson K, Clark D. The challenges of renal replacement therapy and renal palliative care in the elderly. J R Coll Physicians Edinb. 2011;41(3):238–43.
  24. Mandigers CM, de Jong W, van den Wall Bake AW, Gerlag PG. Renal replacement therapy in the elderly. Neth J Med. 1996;49(4):135–42.
  25. Birmele B, Francois M, Pengloan J, Francois P, Testou D, Brillet G, et al. Death after withemodialysisrawal from dialysis: the most common cause of death in a French dialysis population. Nephrol Dial Transplant. 2004;19:686–91.
  26. Latos DL. Chronic dialysis in patients over age 65. J Am Soc Nephrol. 1996;7:637–46.
  27. Harris SA, Lamping DL, Brown EA, Constantinovici N. North Thames Dialysis Study (NTDS) Group. Clinical outcomes and quality of life in elderly patients on peritoneal dialysis versus hemodialysis. Perit Dial Int. 2002;22(4):463–70.
  28. Moldovan D, Moldovan I, Rusu C, Kacso I, Patiu IM, Gherman-Caprioara M. FGF-23, vascular calcification, and cardiovascular diseases in chronic hemodialysis patients. Int Urol Nephrol. 2013 Apr 3 [Epub ahead of print].
  29. Yeun JY, Levine RA, Mantadilok V, Kaysen GA. C-Reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis. 2000;35(3):469–76.
  30. Weale R, Bevis P, Neary WD, Boyes S, Morgan JD, Lear PA, et al. Radiocephalic and brachiocephalic arteriovenous fistula outcomes in the elderly. J Vasc Surg. 2008;47:144–50.
  31. Lazarides MK, Georgiadis GS, Antoniou GA, Staramos DN. A meta-analysis of dialysis access outcome in elderly patiens. J Vasc Surg. 2007;45:420–26.
  32. Mazzuchi N, Carbonell E, Fernandez-Cean J. Importance of blood pressure control in hemodialysis patient survival. Kidney Int. 2000;58: 2147–54.
  33. Salam MM, Bower J. Hypertension in the hemodialysis population: Any relation to ine-year survival? Am J Kidney Dis. 1996;28:737–40.
  34. Chandna SM, Da Silva-Gane M, Marshall C, Warwicker P, Greenwood RN, Farrington K. Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy. Nephrol Dial Transplant. 2011;26(5):1608–14.

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