Chronic dialysis in elderly and senile patients: survival and factors affecting outcome. Single-center experience

Objective. Evaluation of the survival and mortality predictors in patients ≥60 years of age on chronic dialysis (CD).

Material and methods. Data analysis of 199 patients ≥60 years of age on CD: 183 (92%) on program hemodialysis (PHD),
16 (8%) on continuous ambulatory peritoneal dialysis (CAPD).

Results. Median survival was 279 days for PHD, and 650 for CAPD; 1-year survival for PHD was 46.5±3.8%, for CAPD – 81.2±9.8%, 2-year survival for PHD was 33, 3±3.9%, for CAPD – 37.2±13%. Univariate analysis of mortality predictors: PHD vs CAPD method (hazard ratio – RR=1.9, 95% confidence interval – CI 1.04-3.6), age (RR=1.7, 95% CI 1.1-2.6), the presence of type 2 diabetes mellitus – DM2 (RR=1.5, 95% CI 1.1–2.2), the presence of overhydration (RR =1.7, 95% CI 1.2–2.4), pre-dialysis creatinine (Cr) (RR=1.1, 95% CI 1.03–1.2) and urea levels (RR=1.04, 95% CI 1.02–1.05). Multivariate analysis of mortality predictors: age, at the first year of treatment: Cr>1000 µmol/L, urea>45 mmol/L, start of renal replacement therapy (RRT) by PHD.

Conclusion. The peak of mortality in elderly patients occurs in the first year of PHD. CAPD can be considered as 1st line RRT in patients ≥60 years of age. To improve the first year survival of patients on RRT, further study of mortality predictors is required.