Clinical characteristics of very elderly patients at hemodialysis initiation

The patient's clinical features at hemodialysis initiation can affect their prognosis in the subsequent dialysis period; however, these features have not been fully elucidated in very elderly subjects. The purpose of this study was to clarify the clinical characteristics associated with cardiovascular and chronic kidney disease at hemodialysis initiation.

Twenty consecutive very elderly patients with end-stage renal disease (ESRD) (≥80 years; VE group) and 35 consecutive control patients with ESRD (<60 years; control group) were included in this study. All patients had started maintenance hemodialysis therapy at our institution. We evaluated the clinical characteristics, laboratory data, thoracic aortic calcification (TAC) and echocardiographic parameters, including aortic valve calcification (AVC), mitral valve calcification and mitral annular calcification (MAC).

The diastolic blood pressure was significantly lower and pulse pressure values were significantly higher in the VE group than in the control group, whereas the estimated glomerular filtration rate and cardiac function were comparable between the two groups. Despite having lower serum phosphate and calcium-phosphate product levels, the VE group exhibited more severe TAC, AVC and MAC than the control group. Furthermore, the duration of hospitalization was significantly shorter in the very elderly patients followed by nephrologists than in those who were not.

Our findings suggest that atherosclerotic lesions are more severe in very elderly patients at hemodialysis initiation.