Analyses of factors concerning the short-term outcome of elderly patients beginning dialysis

Abstract

The aim of the present study is to clarify relevant factors concerning the short-term outcome of elderly patients beginning dialysis. One hundred nineteen patients aged 60 years and over who had newly started dialysis at our hospital were studied. The male/female ratio was 70:49. The age was 74 +/- 7 years (mean +/- standard deviation). In all patients, the timing of referral to a nephrologist (early/late), the urgency of the initiation of dialysis (non-urgent/urgent), the cause of renal failure (nondiabetes/diabetes), serum albumin concentration, comorbid conditions (cerebrovascular disease, ischemic heart disease, etc.), ambulation, cognitive function, and the outcome (relief/death) were surveyed. Twelve patients did not obtain relief and finally died. The influence of the timing of referral on the urgency of the initiation of dialysis was studied. Furthermore the influence of the urgency of the initiation of dialysis on the outcome was studied. The chi 2 test was used for statistical comparisons. The need for urgent dialysis was less among early referral cases as compared with late referral cases (p < 0.0001). The incidence of death was more frequent in urgent dialysis than in non-urgent dialysis (p = 0.016). Multivariate logistic regression analysis was performed using background factors as explanatory variables and the outcome as a dependent variable. Statistically significant factors were the urgency of the initiation (p = 0.040), serum albumin concentration (p = 0.022), and cerebrovascular disease (p = 0.002). The most common cause of death was severe infectious diseases (pneumonia, sepsis). It was speculated that background factors associated with the outcome could contribute to the onset and the progression of infectious diseases.

Effects of late referral to a nephrologist in patients with chronic renal failure

“…In contrast in North America, the UK and other developed countries, the most common reason for death was withdrawal from the dialysis treatment 15–17 . Fujimaki found that the need for urgent dialysis was less among the ER cases compared with the LR cases 18 . We could not find any similar study conducted in Turkey regarding this phenomenon.…”

“…[15][16][17] Fujimaki found that the need for urgent dialysis was less among the ER cases compared with the LR cases. 18 We could not find any similar study conducted in Turkey regarding this phenomenon.…”

Timing of Nephrology Referral: Influence on Mortality and Morbidity in Chronic Kidney Disease

“…Frimat et al (11) found that the commencement of dialysis in an emergency was associated with late referral. Fujimaki et al also showed an increased need for urgent initial dialysis in late referrals (12). In our study, the maximum number of complications occurred during the first three months of follow up.…”

Timing of referral of chronic kidney disease patients to nephrology services (adult)

“…Fujimaki and Kasuya studied 119 patients older than 60 years of age (mean age = 74 years) and showed increased need for urgent initiation of dialysis in late referred patients 10 . Urgent dialysis was associated with increased mortality.…”