End-Stage Renal Disease versus Death in a Portuguese Cohort of Elderly Patients: An Approach using Competing Event Analysis

Santos, Josefina; Fonseca, Isabel; Malheiro, Jorge; Beirão, Idalina; Lobato, Luísa; Oliveira, Pedro; Cabrita, António

doi:10.1136/jim-2017-000480

Cited by 6 publications

(10 citation statements)

References 51 publications

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“…When we designed our longitudinal cohort study, the main objective was to identify the main predictors for CKD progression and death in elderly CKD patients referred to our outpatient department9. In this report we analyzed their baseline characteristics, cardiovascular risk profile, and cardiovascular disease prevalence.…”

Section: Discussionmentioning

confidence: 99%

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Demographic, clinical characteristics and cardiovascular disease burden in a Portuguese cohort of older chronic kidney disease patients

et al. 2019

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Introduction: Chronic kidney disease (CKD) is an independent risk factor for several unfavorable outcomes including cardiovascular disease (CVD), particularly in the elderly, who represent the most rapidly growing segment of the end-stage kidney disease (ESKD) population. Portugal has the highest European unadjusted incidence and prevalence rates of ESKD. In 2012, we started to follow a cohort of elderly CKD patients, we describe their baseline characteristics, risk profile, and cardiovascular disease burden. Methods: All CKD patients aged 65 years and older referred to our department during 2012 were enrolled. Baseline data included: demographic, CKD stage, medication, comorbid conditions. Estimated glomerular filtration rate (eGFR) was calculated by the CKD-EPI formula. Results: A total of 416 patients, 50% referred by primary care physicians, aged 77 ± 7 years, 52% male, with a median eGFR of 32 mL/min/1.73m2 participated in the study. Fifty percent had diabetes (DM), 85% dyslipidemia, 96% hypertension; 26% were current/former smokers, and 24% had a body mass index > 30 kg/m2. The prevalence of CVD was 62% and higher in stage 4-5 patients; in diabetics, it gradually increased with CKD progression (stage 3a < stage 3b < stage 4-5) (39, 58, 82%; p < 0.001). Conclusions: At baseline, our CKD elderly cohort had a higher burden of CVD. The prevalence of CVD was greater than in other European CKD cohorts. Lower level of eGFR was associated with a greater burden of CVD and was more pronounced in diabetics, highlighting the importance of strategically targeting cardiovascular risk reduction in these patients.

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Section: Discussionmentioning

confidence: 99%

“…In 2012, we started to follow a cohort of elderly patients until the occurrence of the first event (ESKD or death)9. In this report we describe their baseline demographic and clinical characteristics, with particular emphasis for the cardiovascular disease burden, to define improved strategies of care.…”

Section: Introductionmentioning

confidence: 99%

Demographic, clinical characteristics and cardiovascular disease burden in a Portuguese cohort of older chronic kidney disease patients

et al. 2019

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“…These results are slightly superior to those found in previous studies. [26][27][28][29] We can speculate about the reasons for this difference, namely our patients were older and demanded urgent start hemodialysis which are two known conditions for worse outcomes. Nonetheless, age at dialysis start, did not modified the association between frailty, comorbidity, and death.…”

Section: Discussionmentioning

confidence: 93%

Mortality in elderly hemodialysis patients, influence of frailty and comorbidity

Fernandes¹

2023

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Background: Mortality in end-stage kidney disease (ESKD) remains high, especially among the elderly with a higher burden of comorbidity and frailty. In this group, dialysis may not offer better survival compared to conservative management. Frailty defined by clinical frailty scale (CFS) and comorbidity by Charlson Comorbidity Index (CCI) are known independent predictors of mortality. Our aim was to compare which one had higher impact on early mortality in urgent-start hemodialysis patients. Methods: We conducted a retrospective cohort study of patients aged 65 years and over, who started hemodialysis as their first renal replacement therapy (RRT) between January 2014 and December 2020. CFS and mCCI, at time of HD start, were used to evaluate, respectively, frailty and comorbid disease burden. The primary outcome was death in the first 6 months of RRT. Results: During the study period 166 patients were included. The median age, at time of hemodialysis start, was 75 years ± 6.3 years. The mortality at 6 months was 19% (n=31). For both scales, the analysis of ROC curve, stablished the optimal cut-off to predict the event death at first 6 months as ≥ 5points. The performance of CFS was superior to the mCCI, in fact, the area under the curve was significantly higher in CFS (0.739) versus the mCCI (0.620). A CFS≥5 had a sensitivity/specificity of 94%/44% in prediction the primary outcome. On the other hand, a mCCI≥5 predicts the same outcome with a sensitivity/specificity of 26%/88%. The diagnostic odds ratio for CFS≥5 was 11.6, compared to only 2.7 for mCCI≥5. Lastly, we constructed a model in which both scores interacted (as categorical variables), which after multivariable adjustment showed that mCCI/CFS <5/≥5 and ≥5/≥5 were independent predictors of mortality (HR=7.06; P=0.017; HR=10.708; P=0.002; respectively). Interestingly, no events were observed in the mCCI≥5/CFS<5 group. Conclusions: In this cohort of urgent-start incident HD patients, frailty defined by CFS was a stronger predictor of mortality than comorbidity defined by CCI.

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“…Only a few studies investigated mortality and kidney prognosis in elderly CKD patients, 9,18–21 and the incidence of KFRT and death varies. This may be due to differences in patient backgrounds, such as race, baseline kidney function and prevalence of proteinuria, as well as differences in treatment strategies and observation periods.…”

Section: Discussionmentioning

confidence: 99%

“…In a French prospective observational study of 155 CKD patients aged 80 years and older with CKD stages G3b to G5, the 3‐year probabilities of death and KFRT was 27% and 11%, respectively 19 . A Portuguese study investigating the prognosis of 416 patients with CKD aged 65 years or older found that 8.7% of patients progressed to KFRT and 24.8% died during a median follow‐up of 3.6 years 20 . In our study, the cumulative incidence of KFRT and death at 5 years was 47% and 12%, which is higher incidence of KFRT, and lower mortality compared to the previous reports.…”

Section: Discussionmentioning

confidence: 99%

Risk factor for progression to kidney failure with replacement therapy in elderly patients with chronic kidney disease: A retrospective single‐centre cohort study

et al. 2023

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Background: Although the number of elderly patients with chronic kidney disease (CKD) has increased, few studies have examined their prognosis. Methods:The study design was a retrospective cohort study at a single centre. We evaluated 301 patients aged ≥75 years old with CKD stage G3a to G5. The primary endpoint was kidney failure with replacement therapy (KFRT) and secondary endpoints were all-cause mortality and annual decline rates of estimated glomerular filtration rate (eGFR). The incidence of KFRT was estimated using the cumulative incidence method considering the competing risk of death. To identify the independent risk factors related to KFRT, multivariate Fine-Gray regression model analysis were performed. Results:The median age of the patients was 79 years and the median eGFR was 24.0 mL/min/1.73 m 2 at baseline. Urinary protein was positive in 70% of patients. With a median follow-up of 24.5 months, 35% of the patients developed KFRT and 9% died.Kidney survival significantly decreased according to the CKD stage at baseline. In patients without proteinuria, the cumulative incidence of KFRT increased in CKD stage G5 patients, while in patients with proteinuria, the incidence of KFRT increased from patients with CKD stage G3b. Multivariate Fine-Gray regression model revealed that less aged, CKD stage G5, baseline data such as proteinuria, hypoalbuminemia, hyperphosphatemia, and hyperuricemia were independent risk factors for KFRT. Conclusion:Elderly CKD patients with proteinuria need to be carefully monitored even at an early CKD stage because of the risk of developing KFRT.

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End-Stage Renal Disease versus Death in a Portuguese Cohort of Elderly Patients: An Approach using Competing Event Analysis

Cited by 6 publications

References 51 publications

Demographic, clinical characteristics and cardiovascular disease burden in a Portuguese cohort of older chronic kidney disease patients

Demographic, clinical characteristics and cardiovascular disease burden in a Portuguese cohort of older chronic kidney disease patients

Mortality in elderly hemodialysis patients, influence of frailty and comorbidity

Risk factor for progression to kidney failure with replacement therapy in elderly patients with chronic kidney disease: A retrospective single‐centre cohort study

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