The clinical status and survival in elderly dialysis: example of the oldest region of France

Abstract

BackgroundThe number of elderly (≥75 years) patients with end-stage renal disease (ESRD) has increased markedly, including in the Limousin region, which has the oldest population in France. We retrospectively compared outcomes in elderly and non-elderly ESRD patients who started dialysis during two time periods.MethodsBaseline clinical characteristics, care, and survival rates were assessed in 557 ESRD patients aged ≥75 and <75 years who started dialysis in 2002–2004 and 2005–2007. Survival curves and Cox proportional hazards model were used to assess survival and factors associated with survival.ResultsOf the 557 patients, 343 and 214 were <75 years and ≥75 years, respectively. Dialysis was started in 2002–2004 and 2005–2007 by 197 and 146 patients <75 years, respectively, and by 96 and 118 patients ≥75 years, respectively. Median age (73.4 years [interquartile range [IQR] 61.7-79.5 years] vs 69.5 years [IQR 57.4-77.4 years] p = 0.001) and the proportion aged ≥75 years (44.7% vs 32.8%, p = 0.004) were significantly higher in 2005–2007 than in 2002–2004. Improved initial status during 2005–2007 was observed only in patients ≥75 years, with a decrease in some co-morbidities, improved walking and better preparation for dialysis. Mortality rates were significantly lower in 2005–2007 than in 2002–2004 (hazard ratio 0.81, 95% confidence interval 0.69-0.95; p = 0.008), with the difference due to factors associated with clinical status and care.ConclusionsImproved initial clinical status and better preparation for dialysis, accompanied by increased survival, were observed for patients ≥75 years who started dialysis more recently, perhaps because of early referral to a nephrologist.

Functional and Cognitive Impairment, Frailty, and Adverse Health Outcomes in Older Patients Reaching ESRD—A Systematic Review

“…The prevalence of impaired mobility in patients reaching ESRD was 7%-34% among the included studies (32)(33)(34)(35)(36)(37)(38)(39). Nine studies addressed mobility, and all nine reported immobility to be significantly associated with a higher risk of mortality, independent of sex and calendar age (32)(33)(34)(35)(36)(37)(38)(39)(40).…”

“…Nine studies addressed mobility, and all nine reported immobility to be significantly associated with a higher risk of mortality, independent of sex and calendar age (32)(33)(34)(35)(36)(37)(38)(39)(40). Mobility status was assessed in all studies by using data on whether the patient was dependent for transfers and walking without objectifying actual mobility (for instance, by measuring gait speed).…”

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. [11][12][13][14] CGA is a multidimensional procedure designed to evaluate an older person's physical health, functional ability, cognition and mental health, and socioenvironmental circumstances, as well as an extensive review of prescriptions.…”

Nonalcoholic fatty liver disease (NAFLD) &ndash; a new factor that interplays between inflammation, malnutrition, and atherosclerosis in elderly hemodialysis patients

“…With advancing age come challenges to maintaining the nutritional status of these patients. In contrast to the general population, for whom overnutrition or obesity is associated with increased cardiovascular disease (CVD) risk, in patients who are maintained on HD, malnutrition and malnutrition-inflammation complex syndrome are associated with poor outcome 1,2. According to many authors, a significant number of HD patients display some degree of malnutrition, and malnutrition has been identified as one of the most powerful predictors of outcome in HD patients 1–3.…”

“…It is important to recognize and prevent malnutrition in this potentially fragile population. There are no special requirements for the assessment of nutritional status in the elderly – as with younger patients, a panel of tests should be carried out since no one test can adequately assess all aspects of nutritional status 2,3…”