Wouter R Verberne1, A B M Tom Geers2, Wilbert T Jellema2, Hieronymus H Vincent2, Johannes J M van Delden3, Willem Jan W Bos2. 1. Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands; and w.verberne@antoniusziekenhuis.nl. 2. Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands; and. 3. University Medical Center Utrecht, Julius Center for Health Sciences, Utrecht, The Netherlands.
Abstract
BACKGROUND AND OBJECTIVES: Outcomes of older patients with ESRD undergoing RRT or conservative management (CM) are uncertain. Adequate survival data, specifically of older patients, are needed for proper counseling. We compared survival of older renal patients choosing either CM or RRT. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A retrospective survival analysis was performed of a single-center cohort in a nonacademic teaching hospital in The Netherlands from 2004 to 2014. Patients with ESRD ages ≥70 years old at the time that they opted for CM or RRT were included. Patients with acute on chronic renal failure needing immediate start of dialysis were excluded. RESULTS: In total, 107 patients chose CM, and 204 chose RRT. Patients choosing CM were older (mean±SD: 83±4.5 versus 76±4.4 years; P<0.001). The Davies comorbidity scores did not differ significantly between both groups. Median survival of those choosing RRT was higher than those choosing CM from time of modality choice (median; 75th to 25th percentiles: 3.1, 1.5-6.9 versus 1.5, 0.7-3.0 years; log-rank test: P<0.001) and all other starting points (P<0.001 in all patients). However, the survival advantage of patients choosing RRT was no longer observed in patients ages ≥80 years old (median; 75th to 25th percentiles: 2.1, 1.5-3.4 versus 1.4, 0.7-3.0 years; log-rank test: P=0.08). The survival advantage was also substantially reduced in patients ages ≥70 years old with Davies comorbidity scores of ≥3, particularly with cardiovascular comorbidity, although the RRT group maintained its survival advantage at the 5% significance level (median; 75th to 25th percentiles: 1.8, 0.7-4.1 versus 1.0, 0.6-1.4 years; log-rank test: P=0.02). CONCLUSIONS: In this single-center observational study, there was no statistically significant survival advantage among patients ages ≥80 years old choosing RRT over CM. Comorbidity was associated with a lower survival advantage. This provides important information for decision making in older patients with ESRD. CM could be a reasonable alternative to RRT in selected patients.
BACKGROUND AND OBJECTIVES: Outcomes of older patients with ESRD undergoing RRT or conservative management (CM) are uncertain. Adequate survival data, specifically of older patients, are needed for proper counseling. We compared survival of older renal patients choosing either CM or RRT. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A retrospective survival analysis was performed of a single-center cohort in a nonacademic teaching hospital in The Netherlands from 2004 to 2014. Patients with ESRD ages ≥70 years old at the time that they opted for CM or RRT were included. Patients with acute on chronic renal failure needing immediate start of dialysis were excluded. RESULTS: In total, 107 patients chose CM, and 204 chose RRT. Patients choosing CM were older (mean±SD: 83±4.5 versus 76±4.4 years; P<0.001). The Davies comorbidity scores did not differ significantly between both groups. Median survival of those choosing RRT was higher than those choosing CM from time of modality choice (median; 75th to 25th percentiles: 3.1, 1.5-6.9 versus 1.5, 0.7-3.0 years; log-rank test: P<0.001) and all other starting points (P<0.001 in all patients). However, the survival advantage of patients choosing RRT was no longer observed in patients ages ≥80 years old (median; 75th to 25th percentiles: 2.1, 1.5-3.4 versus 1.4, 0.7-3.0 years; log-rank test: P=0.08). The survival advantage was also substantially reduced in patients ages ≥70 years old with Davies comorbidity scores of ≥3, particularly with cardiovascular comorbidity, although the RRT group maintained its survival advantage at the 5% significance level (median; 75th to 25th percentiles: 1.8, 0.7-4.1 versus 1.0, 0.6-1.4 years; log-rank test: P=0.02). CONCLUSIONS: In this single-center observational study, there was no statistically significant survival advantage among patients ages ≥80 years old choosing RRT over CM. Comorbidity was associated with a lower survival advantage. This provides important information for decision making in older patients with ESRD. CM could be a reasonable alternative to RRT in selected patients.
Authors: Fliss E M Murtagh; James E Marsh; Paul Donohoe; Nasirul J Ekbal; Neil S Sheerin; Fiona E Harris Journal: Nephrol Dial Transplant Date: 2007-04-04 Impact factor: 5.992
Authors: Kai-Uwe Eckardt; Iain A Gillespie; Florian Kronenberg; Sharon Richards; Peter Stenvinkel; Stefan D Anker; David C Wheeler; Angel L de Francisco; Daniele Marcelli; Marc Froissart; Jürgen Floege Journal: Kidney Int Date: 2015-04-29 Impact factor: 10.612
Authors: Ismay N van Loon; Namiko A Goto; Franciscus T J Boereboom; Michiel L Bots; Marianne C Verhaar; Marije E Hamaker Journal: Clin J Am Soc Nephrol Date: 2017-07-17 Impact factor: 8.237
Authors: Andrei D Javier; Rocio Figueroa; Edward D Siew; Huzaifah Salat; Jennifer Morse; Thomas G Stewart; Rakesh Malhotra; Manisha Jhamb; Jane O Schell; Cesar Y Cardona; Cathy A Maxwell; T Alp Ikizler; Khaled Abdel-Kader Journal: Am J Kidney Dis Date: 2017-02-15 Impact factor: 8.860
Authors: Maria E Montez-Rath; Yuanchao Zheng; Manjula Kurella Tamura; Vanessa Grubbs; Wolfgang C Winkelmayer; Tara I Chang Journal: J Gen Intern Med Date: 2017-08-14 Impact factor: 5.128
Authors: Susan P Y Wong; Saritha Boyapati; Ruth A Engelberg; Bjorg Thorsteinsdottir; Janelle S Taylor; Ann M O'Hare Journal: Am J Kidney Dis Date: 2019-09-27 Impact factor: 8.860
Authors: Keren Ladin; Renuka Pandya; Allison Kannam; Rohini Loke; Tira Oskoui; Ronald D Perrone; Klemens B Meyer; Daniel E Weiner; John B Wong Journal: Am J Kidney Dis Date: 2018-02-01 Impact factor: 8.860