U N Peri1, A Z Fenves, J P Middleton. 1. Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-8856, USA.
Abstract
BACKGROUND: The incidence of end-stage renal disease (ESRD) among patients over the age of 80 has nearly tripled in the last decade, making the 'old-old' the fastest growing ESRD demographic group. Despite this, very little information is available on the characteristics and survival of patients who initiate haemodialysis (HD) after reaching this age. METHODS: We performed a retrospective study on all patients who entered an outpatient HD programme after the age of 80, from January 1988 to September 1998. A total of 106 charts were reviewed from a single nephrology practice group. Eleven patients were excluded due to incomplete data. The survival probability was calculated using the Kaplan-Meier method. RESULTS: The characteristics of 95 patients were as follows: mean age at initiation of dialysis, 83.7 years; female, 50.5%; Caucasian, 40.0%, African-American, 30.0%; Hispanic, 10.0%; Asian, 4.3%; polytetrafluorethylene grafts, 80.0%; primary fistulas, 5.6%; tunnelled catheters, 5.6%; mean established Kt/V, 1.68; urea reduction ratio (URR), 0.74; estimated dry weight (EDW), 60.3 kg. ESRD was attributed to hypertension in 37%, diabetes in 22% and analgesic use in 8%. The 1-, 2- and 5-year survival probability of the entire group was 82.6+/-4.0%, 64.0+/-5.6%, and 19.6+/-6.0%, respectively. The median survival was 29 months. When comparing survival probability of patients who were in the highest quartiles of URR and EDW to those in the lowest quartile there was no discernible difference. However, the 2-year survival probability of patients initiated after January 1, 1995 (76.9+/-8.4) was significantly better than those initiated from 1988-1994 (47.8+/-6.5; P<0.05). CONCLUSIONS: From analysis of this cohort, we conclude that: (i) elderly patients selected for outpatient HD programmes have substantially better survival than previously reported; (ii) Kt/V does not correlate with survival in this demographic group; and (iii) contemporary dialysis practice is associated with better likelihood of survival of elderly patients in outpatient HD programmes.
BACKGROUND: The incidence of end-stage renal disease (ESRD) among patients over the age of 80 has nearly tripled in the last decade, making the 'old-old' the fastest growing ESRD demographic group. Despite this, very little information is available on the characteristics and survival of patients who initiate haemodialysis (HD) after reaching this age. METHODS: We performed a retrospective study on all patients who entered an outpatientHD programme after the age of 80, from January 1988 to September 1998. A total of 106 charts were reviewed from a single nephrology practice group. Eleven patients were excluded due to incomplete data. The survival probability was calculated using the Kaplan-Meier method. RESULTS: The characteristics of 95 patients were as follows: mean age at initiation of dialysis, 83.7 years; female, 50.5%; Caucasian, 40.0%, African-American, 30.0%; Hispanic, 10.0%; Asian, 4.3%; polytetrafluorethylene grafts, 80.0%; primary fistulas, 5.6%; tunnelled catheters, 5.6%; mean established Kt/V, 1.68; urea reduction ratio (URR), 0.74; estimated dry weight (EDW), 60.3 kg. ESRD was attributed to hypertension in 37%, diabetes in 22% and analgesic use in 8%. The 1-, 2- and 5-year survival probability of the entire group was 82.6+/-4.0%, 64.0+/-5.6%, and 19.6+/-6.0%, respectively. The median survival was 29 months. When comparing survival probability of patients who were in the highest quartiles of URR and EDW to those in the lowest quartile there was no discernible difference. However, the 2-year survival probability of patients initiated after January 1, 1995 (76.9+/-8.4) was significantly better than those initiated from 1988-1994 (47.8+/-6.5; P<0.05). CONCLUSIONS: From analysis of this cohort, we conclude that: (i) elderly patients selected for outpatientHD programmes have substantially better survival than previously reported; (ii) Kt/V does not correlate with survival in this demographic group; and (iii) contemporary dialysis practice is associated with better likelihood of survival of elderly patients in outpatientHD programmes.
Authors: Bernard Canaud; Lin Tong; Francesca Tentori; Takashi Akiba; Angelo Karaboyas; Brenda Gillespie; Tadao Akizawa; Ronald L Pisoni; Juergen Bommer; Friedrich K Port Journal: Clin J Am Soc Nephrol Date: 2011-07 Impact factor: 8.237
Authors: Gang Jee Ko; Yoshitsugu Obi; Tae Ik Chang; Melissa Soohoo; Rieko Eriguchi; Soo Jeong Choi; Daniel L Gillen; Csaba P Kovesdy; Elani Streja; Kamyar Kalantar-Zadeh; Connie M Rhee Journal: J Am Med Dir Assoc Date: 2019-01-25 Impact factor: 4.669