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Survival of patients ≥70 years with advanced chronic kidney disease: Dialysis vs. conservative care
Yeleine Martínez Echevers1, Néstor Gabriel Toapanta Gaibor1, Nathasha Nava Pérez1
1UGC Nefrología-Urología, Hospital Universitario Virgen del Rocío, Sevilla, España.
Insights
Dialysis improves survival for elderly patients with advanced chronic kidney disease (ACKD) stages 4 and 5. However, this survival benefit is not observed in patients aged 80 and older.
Area of Science:
- Nephrology
- Geriatrics
- Public Health
Background:
- Increasing prevalence of elderly patients with advanced chronic kidney disease (ACKD).
- Limited evidence on optimal therapeutic strategies for ACKD in the elderly population.
Purpose of the Study:
- To track the progression of ACKD (stages 4-5) in elderly individuals (≥70 years).
- To compare survival rates between stage 5 CKD patients who received dialysis and those who did not.
Main Methods:
- Retrospective study of 314 patients aged ≥70 years with stages 4-5 CKD.
- Data collected included demographics, Charlson comorbidity index, history of ischemic heart disease (IHD), and diabetes mellitus (DM).
- Survival analysis using Kaplan-Meier curves for patients with and without dialysis.
Main Results:
- 162 patients had stage 5 CKD; 69 received dialysis.
- Dialysis patients were younger with lower comorbidity scores and shorter follow-up.
- Kaplan-Meier survival analysis showed improved survival for dialysis patients aged <80 years (P<.001 for ≥70, P=.003 for ≥75).
Conclusions:
- Dialysis treatment enhances survival in elderly patients with advanced chronic kidney disease.
- The survival advantage of dialysis diminishes significantly in patients aged 80 years and older.
Introduction:
The number of elderly patients with advanced chronic kidney disease (ACKD) has increased in recent years, and the best therapeutic approach has not been determined due to a lack of evidence.
Objectives:
To observe the progression of elderly patients with ACKD (stages 4 and 5) and to compare the survival of stage 5 CKD patients with and without dialysis treatment.
Material And Methods:
All patients ≥70 years who began ACKD follow-up from 01/01/2007 to 31/12/2008 were included, and their progression was observed until 31/12/2013. Demographic data, the Charlson comorbidity index, history of ischaemic heart disease (IHD) and diabetes mellitus (DM) were assessed.
Results:
A total of 314 patients ≥70 years with stages 4 and 5 CKD were studied. Of these patients, 162 patients had stage 5 CKD at the beginning of follow-up or progressed to stage 5 during the study, and 69 of these patients were treated with dialysis. In the stage 5 group: median age was 77 years (74-81); 48% had IHD; 50% had DM, Charlson 7 (6-9). Kaplan-Meier survival analysis: ≥70 years (93 vs. 69 patients with dialysis, log rank: 15 P<.001); patients ≥75 years (74 vs. 46 patients with dialysis, log rank: 8.9 P=.003); patients ≥80 (40 vs. 15 patients with dialysis) and p=0,2. Patients receiving dialysis were younger, with a lower Charlson comorbidity index and shorter follow-up time.
Conclusions:
Our study shows that dialysis treatment improves survival, although this benefit is lost in patients ≥80 years.
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