Factors Predicting Mortality in Elderly Patients on Dialysis

Abstract

Elderly patients are increasingly enrolled in dialysis programs and present a series of special characteristics due to their high morbidity and mortality. Objective:To describe the characteristics of incident dialysis patients aged >75 years, their comorbidities and their admissions, with a view to determining the factors that influence their course and mortality. Patients and Methods: The study included all patients aged >75 years who started dialysis in our center since January 2000. The mean duration of follow-up was 3.3 ± 2.2 years. Data were collected on incident comorbidity, admissions and their causes. A total of 139 patients were included, with a mean age of 78.6 ± 2.6 years (67.6% males, 33.8% diabetic and 7.9% on peritoneal dialysis). Three groups were established according to age: 75–79, 80–85 and >85 years. The most frequent comorbidities were chronic obstructive pulmonary disease (25.9%), ischemic heart disease (25.2%), heart failure (25.9%), neoplasms (23.7%), peripheral vascular disease (23.7%), cerebrovascular disease (18.7%) and arterial hypertension (81%). The Charlson index was calculated, not adjusted for age, and comorbidity tertiles were established. Results: During follow-up, the patients presented 0.82 ± 0.99 admissions/patient/year, with a duration of 12.1 ± 20.6 days/patient/year. The main causes of admission were infection (33%), vascular access problems (27%) and peripheral vascular events (14%). A total of 61 patients died (44%), and 4 underwent kidney transplantation (2.9%). The mean duration of follow-up of the transplanted patients was 3.6 ± 1.8 years. The main causes of death were infection (32%), cardiovascular problems (28.3%) and neoplastic disease (11.3%). The global survival rate was 90, 82 and 53% after 1, 2 and 5 years, respectively. No significant differences in survival or annual admission rate were found in relation to age group and dialysis technique. In contrast, the annual admission rate and days of admission were directly correlated to the Charlson index (p = 0.009 and p = 0.032, respectively). No significant differences in the Charlson index were found between the patients on hemodialysis and those subjected to peritoneal dialysis. In the univariate model, the factors associated to mortality were diabetes, chronic obstructive pulmonary disease, heart failure and the Charlson index. In the multivariate model, only the Charlson index remained as an independent predictive factor (p = 0.006). Conclusions: Unlike the general population, age does not influence mortality or admissions in elderly patients on dialysis. Incident comorbidity is the factor exerting the greatest influence upon mortality and admissions. Advanced age in itself should not be regarded as an excluding factor for starting dialysis.

Hemodialysis in Patients Over 80 Years

“…The survival of our patients beyond age 80 is similar or even better in comparison to other single-center studies of recent years [5,8,9]. Single-center data usually show better results than registry data, which represent all patients.…”

Daptomycin Pharmacokinetics and Pharmacodynamics in a Pooled Sample of Patients Receiving Thrice-Weekly Hemodialysis

“…Given the morbidity and mortality associated with infections in HD patients, knowledge of the most optimal dosing scheme for a given antimicrobial is critical for ensuring the highest probability of success (3). For a number of antibiotics, multiple dosing recommendations in HD patients have been published (25).…”

“…Of these, more than 300,000 receive thrice-weekly hemodialysis (HD) as their primary mode of kidney replacement therapy. Infections among patients on HD are common and account for nearly 30% of all deaths in this population (2,3). One of the most common pathogens associated with infections in the HD population is methicillin-resistant Staphylococcus aureus (MRSA) (4,5).…”

Comprehensive geriatric assessment: comparison of elderly hemodialysis patients and primary care patients

“…6,7 It was reported that improved initial clinical status of elderly end-stage renal disease (ESRD) patients and better preparation for dialysis was associated with increased survival. 8 Decreased functional capacity, sensory deficits, cognitive impairment and depression have frequently been found in hemodialysis (HD) patients [9][10][11] but only a few studies used comprehensive geriatric assessment (CGA) to evaluate HD patients.…”