Broadening Options for Long-term Dialysis in the Elderly (BOLDE): differences in quality of life on peritoneal dialysis compared to haemodialysis for older patients

Abstract

Background. Health-related quality of life (QOL) is an important outcome for older people who are often on dialysis for life. Little is, however, known about differences in QOL on haemodialysis (HD) and peritoneal dialysis (PD) in older age groups. Randomising patients to either modality to assess outcomes is not feasible.Methods. In this cross-sectional, multi-centred study we conducted QOL assessments (Short Form-12 Mental and Physical Component Summary scales, Hospital Anxiety and Depression Scale and Illness Intrusiveness Ratings Scale) in 140 people (aged 65 years or older) on PD and HD.Results. The groups were similar in age, gender, time on dialysis, ethnicity, Index of Deprivation (based on postcode), dialysis adequacy, cognitive function (Mini-Mental State Exam and Trail-Making Test B), nutritional status (Subjective Global Assessment) and social networks. There was a higher comorbidity score in the HD group. Regression analyses were undertaken to ascertain which variables significantly influence each QOL assessment. All were influenced by symptom count highlighting that the patient’s perception of their symptoms is a critical determinant of their mental and physical well being. Modality was found to be an independent predictor of illness intrusion with greater intrusion felt in those on HD.Conclusions. Overall, in two closely matched demographic groups of older dialysis patients, QOL was similar, if not better, in those on PD. This study strongly supports offering PD to all suitable older people.

Renal Replacement Therapy in the Elderly Population

“…There was no difference in 1-year mortality in 125 patients older than age 70 years in the North Thames Dialysis Study (57). The BOLDE (Broadening Options for Long-term Dialysis in the Elderly) study found similar quality of life for PD versus HD in prevalent elderly (.65 years) patients (49). In 3512 incident French dialysis patients older than 75 years (Renal Epidemiology and Information Network registry), the 2-year PD survival rate was 64%, similar to that seen with HD (58).…”

“…Although HD may be an effective and attractive option (supervised, not done daily), elderly patients are generally more sensitive to fluid shifts because of increased cardiovascular comorbidity and may not tolerate ultrafiltration (49,50). In addition, problems with transportation and vascular access can limit success.…”

“…Peritoneal dialysis (PD) may be advantageous because it provides gentler ultrafiltration, can be performed at home, and eliminates vascular access. However, barriers may exist because of functional limitations and insufficient social support; these factors, although present in younger patients, are more frequent and problematic in elderly (49,51).…”

The Ethics of Chronic Dialysis for the Older Patient

“…Indeed, living-donor kidney transplantation can be a viable option, even for elderly patients, if they meet set criteria (30). Peritoneal dialysis is an acceptable alternative to in-center hemodialysis in terms of survival (31), satisfaction (32), and improved quality of life for many elderly patients (33). Initiation of hemodialysis can sometimes be delayed by a very-low-protein diet, and an Italian study achieved an average delay for hemodialysis commencement of 10.9 months (34).…”

A Brazilian Experience in Assisted Automated Peritoneal Dialysis: A Reliable and Effective Home Care Approach

“…For elderly patients, peritoneal dialysis (PD) offers advantages of particular interest, such avoidance of the need to travel to the dialysis center three times each week (9), less hemodynamic instability (9), lower risk of central venous catheter-associated bacteremia (10), and better control of blood pressure (10,11). Beyond the cognitive, social, physical, and psychological limitations (12,13) of such patients, many associated comorbidities may also be present, complicating implementation of the PD technique, because many elderly patients live by themselves and have no family support (14).…”