P1463amortality and Hospitalization Patterns in Elderly Hemodialysis Patients. A Large Saudi Study

Abstract

Background and Aims The aim of the study was to analyze hospitalization and mortality parameters in Saudi elderly patients undergoing hemodialysis for end stage renal disease. Method The study population included all patients admitted at Davita-KSA clinics to continue renal replacement by hemodialysis during the period October 2014-December 2018. Two groups were identified according to age at admission to Davita clinics: Group 1 (age>=65 years), Group 2 (age<65 years). Zero time data, including demographic and clinical characteristics were recorded at admission. Also, all deaths and morbid events necessitating hospital admission were regularly recorded during the follow-up period. Annual mortality and hospitalization rates with the corresponding confident intervals were calculated as appropriate. Survival rates were calculated according to actuarial method logistic regression was used to identify factors influencing hospitalization and mortality. Results Elderly patients represented 23.84% of 3508 included patients (G1),). The sex ratio was of 1.07 Vs. 1.21 in control group (NS). ESRD was attributed to diabetes in 52.7% of elderly patients Vs. 36.3% in others (<0.0001). The median duration of HD before joining Davita-clinics was of 6.5 months in G1 Vs. 11.5 months in G2 (p<0.0001). There is no significant difference between the 2 groups regarding vascular access type, BMI and hemoglobin rate. The proportion of patients who were hospitalized was of 30.8% in G1 Vs. 24.6% in G2 (p<0.0006) corresponding to an annual rate of 37.33% (CI, 95%: [33.93-40.73]) in G1 Vs. 25.64 (CI, 95%: [24.14-27.15]) in G2. The annual rate of hospital stay was of 4.38 days per patient in G1 (CI, 95%: [4.26-4.49]) Vs. 3.11 in G2 (CI, 95%: [3.06-3.16]). The annual mortality rate was 13.36% in G1 (CI, 95%: [11.32-15.38]) Vs. 5.33% in G2 (CI, 95%: [4.64-6.01]). Survival rates in Group 2 were of 98.6, 95.4, 90.5 and 78.6% at 3, 12, 24 and 48 months respectively Vs. 96.1, 89.3, 78.8 and 55.8% in G1 (p<0.0001). Adjusted hospitalization and mortality risks were of 1.271 (CI, 95%: [1.065-1.516]; p<0.008) and 2.257 (CI, 95%: [1.794-2.841]; p<0.0001) in elderly patients compared to other patients. Conclusion Our study demonstrated that Saudi elderly hemodialysis patients remain a group at high risk for hospitalization and mortality.