Mortality in elderly patients starting hemodialysis program

Abstract

Background: The incidence of older patients over 80 years old with chronic kidney disease who start hemodialysis (HD) program has been increasing in the last decade. Methods: We aimed to identify risk factors for morbidity and mortality in patients older than 80 years with end‐stage renal disease who started HD. We conducted a retrospective observational study of the Catalan Renal registry (RMRC). Results: A total of 2833 patients equal or older than 80 years (of 15,137) who started HD between 2002 and 2019 from the RMRC were included in the study. In this group, the first dialysis was performed through an arteriovenous fistula in 44%, percutaneous catheter in 28.2%, and tunneled catheter in 26.6%. Conventional dialysis was used in 65.7% and online HD in 34.3%. The most frequent cause of death was cardiac disease (21.8%), followed by social problems (20.4%) and infections (15.9%). Overall survival in older HD during the first year was 84% versus 91% in younger than 80 years (p < 0.001). Cox regression analysis identified the start of HD in the period 2002–2010, chronic obstructive pulmonary disease (COPD), and the onset of HD through vascular graft depicted as risk factors for first‐year mortality after dialysis initiation in patients older than 80 years with end‐stage renal disease who started HD. Conclusions: In conclusion, patients older than 80 years who started HD program had higher mortality, especially those who presented exacerbation of kidney disease, those with COPD, and those who started with a vascular graft.

The role of low health literacy in shared treatment decision-making in patients with kidney failure

“…More recently, older patients with comorbidities who started a hemodialysis program were reported to have higher mortality; poorer survival and/or quality of life compared with patients who did not start a dialysis program [ 42–45 ]. Therefore, the decision to initiate dialysis in this population requires a nephrological-geriatric evaluation together with family support and trained nephrology nursing in a nephrology unit, using HL, and applying shared decision-making (SDM) [ 45 ]. Patients with limited HL may lack understanding, making them less likely to discuss transplantation with family and friends, affecting recruitment of living donors, who may also have lower HL and health contraindications related to shared social disadvantages [ 22 ].…”

The Influence of Sleep Hygiene on the Sleep Disorders of Elderly at Integrated Long Term Care

“…Sleep disturbances among elderly such as insomnia, circadian rhythm disorders, and sleep-disordered breathing, can lead to deleterious health outcomes. Impaired sleep in the elderly is associated with an increased risk of falls, depression, anxiety, delirium, cognitive impairment, restlessness, fatigue, and daytime sleepiness (Toapanta et al, 2023). Poor sleep also worsens many age-related chronic diseases.…”