Very Old Patients on Hemodialysis: How They Start and Can We Predict Survival?

Gubenšek, Jakob; Ponikvar, Rafael; Ekart, Robert; Buturović‐Ponikvar, Jadranka

doi:10.1159/000367681

Cited by 5 publications

(11 citation statements)

References 24 publications

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“…In our opinion, the early and intensive nephrology pre-dialysis care is the key to a successful dialysis treatment in octogenarians and nonagenarians. A very recent study from Slovenian national registry (170 patients ≥80 years) confirms these results [7]. Gubensek et al found in a multivariate analysis that only age and pre-dialysis nephrology care were independent predictors of survival.…”

Section: Discussionmentioning

confidence: 65%

“…Late referral is a well-known significant independent risk factor influencing dialysis patient's outcomes [7,11,12,13,14]. In a reverse approach, Jungers et al showed that longer duration of regular nephrological care in the pre-dialysis period is associated with better long-term survival on dialysis.…”

Section: Discussionmentioning

confidence: 99%

“…Duration and intensity of pre-dialysis nephrology care depend on referral practice and show considerable regional differences especially when concerning the elderly [1,5,7,8,11,12,13,14,15]. This is mainly due to the varying judgment of referring primary care physicians and non-nephrology specialists [16] who stress on the importance of local networks.…”

Section: Discussionmentioning

confidence: 99%

“…Dialysis data, especially in the age group of octogenarians and nonagenarians, are rare [5,7,8]. Therefore, we analyzed the outcomes of our patients in this age group, particularly going by the influence of pre-ESRD care.…”

Section: Introductionmentioning

confidence: 99%

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Hemodialysis in Patients Over 80 Years

Leimbach¹,

Kron²,

Czerny³

et al. 2015

Nephron

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Background: In Germany, every fifth patient starting dialysis is now 80 years of age or older. The question that is currently relevant is not whether we have to treat patients who are older than 80. Rather the question now is how to treat this elderly group of patients. Methods: Single centre data of all dialysis patients aged over 80 were analyzed with regard to survival, social circumstances, vascular access, and pre-dialysis nephrology care. Results: Between 2001 and 2012, 76 patients over 80 years started chronic ambulatory hemodialysis treatment. One-year survival was 87%, 3-year survival 52%, 5-year survival 27% and 10-year survival 9%. Patients (n = 55) with more than 3 months of nephrological care prior to dialysis (3-161 months, median 31 months) survived significantly longer then patients (n = 21) having had less than 3 months contact with nephrologists. On 31st December 2012 there were 38 patients aged ≥80 (median age 84, 80-95 years) in the chronic hemodialysis program accounting for 19% of all dialysis patients of this center. Thirty patients (79%) had been in long-term nephrological care prior to dialysis initiation (3-161 months, median 45 months). Thirty one patients (82%) started the first dialysis treatment with a functioning shunt access. Conclusion: Long-term pre-dialysis nephrology care is of most importance for successful dialysis treatment in the elderly, especially in octogenarians and nonagenarians. It enables the early establishment of functioning vascular access and careful scheduling of first dialysis treatment and increases survival. The long-term use of catheters can be avoided in almost all patients above the age of 80.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hemodialysis in Patients Over 80 Years

Leimbach¹,

Kron²,

Czerny³

et al. 2015

Nephron

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“…In the first months after starting dialysis, mortality is higher in very elderly patients [7][8][9] . From the sixth month onward, the monthly hazard of death persists [7] , but the patients may also remain stable for many years to come [4,[10][11][12][13][14] . Finally, in all octogenarians and nonagenarians, we always face the process of dying including frailty, loss of autonomy, and heavy burden.…”

Section: Introductionmentioning

confidence: 99%

Comorbidities, Hospitalization, and Living Status of Dialysis Patients Over 80 Years

Leimbach

Kron

Pommer³

et al. 2016

Blood Purif

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Background: An increasing number of patients start dialysis when they are over 80 years or reaches their eighties on dialysis. The burden of dialysis can affect their quality of life. Methods: Clinical and social data of all patients aged 80 years or older who underwent chronic dialysis treatment in a single center were analyzed. Results: Fifty-nine patients aged between 80 and 92 years were in chronic dialysis treatment on December 31, 2015. Median time on dialysis was 57 months (3-330 months). Hospitalization rate and days in hospital were lower in this group than in younger patients (1.05 vs. 1.34 hospitalizations; 8.3 vs. 9.0 hospital days per patient and year) despite the presence of many comorbidities. The median patency of the currently used arteriovenous shunt was 70 months (6-194 months). Social status was comparable with the population of the rest of the same average age range. Conclusion: Dialysis patients aged ≥80 years have a satisfactory quality of life with no more complications than younger patients.

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Temporary Catheters as a Permanent Vascular Access in Very Elderly Hemodialysis Patients: Frequency of Complications and Interventions

et al. 2016

Self Cite

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The choice of vascular access in very elderly hemodialysis patients can be complex. Data on the frequency of interventions and complications when temporary catheters are used for long periods in this population are lacking. All incident patients ≥80 years old, dialyzed over non-tunneled catheters, were included and the frequency of interventions (re-insertions and wire-exchanges) and complications (catheter-related blood stream infections) were recorded. In 31 patients aged 84 ± 4 years, dialyzed for 1.4 ± 1.1 years, 87 interventions were needed (2.02/patient-year). The median time to first intervention was 5.5 months and the 1-year intervention-free rate was 32%. There were three catheter-related blood stream infections (0.2/1000 access-days), comparing favorably to tunneled catheters. To conclude, temporary catheters are associated with a low rate of complications and an acceptable rate of interventions. Therefore, they could be the optimal vascular access in very elderly patients when the placement of an arterio-venous fistula is not feasible.

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Very Old Patients on Hemodialysis: How They Start and Can We Predict Survival?

Cited by 5 publications

References 24 publications

Hemodialysis in Patients Over 80 Years

Hemodialysis in Patients Over 80 Years

Comorbidities, Hospitalization, and Living Status of Dialysis Patients Over 80 Years

Temporary Catheters as a Permanent Vascular Access in Very Elderly Hemodialysis Patients: Frequency of Complications and Interventions

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