Related Experiment Video
Updated: Sep 5, 2025
Surgical Techniques for Catheter Placement and 5/6 Nephrectomy in Murine Models of Peritoneal Dialysis
Published on: July 19, 2018
Mortality in elderly patients starting hemodialysis program
Néstor Toapanta1, Jordi Comas2, Juan León Román1
1Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain.
Insights
Older adults over 80 starting hemodialysis face higher mortality risks. Factors like COPD and vascular graft access increase early death risk in this growing patient population.
Area of Science:
- Nephrology
- Geriatrics
- Public Health
Background:
- Increasing incidence of elderly patients (over 80) with chronic kidney disease initiating hemodialysis.
- Growing need to understand outcomes in this specific demographic.
Purpose of the Study:
- Identify risk factors for morbidity and mortality in end-stage renal disease patients over 80 starting hemodialysis.
- Analyze outcomes in the elderly hemodialysis population.
Main Methods:
- Retrospective observational study using the Catalan Renal registry (RMRC).
- Included 2833 patients aged 80+ who started hemodialysis between 2002 and 2019.
- Utilized Cox regression analysis to identify mortality predictors.
Main Results:
- First-year survival was 84% for patients over 80 versus 91% for those younger than 80.
- Leading causes of death included cardiac disease (21.8%), social problems (20.4%), and infections (15.9%).
- Risk factors for first-year mortality were starting hemodialysis between 2002-2010, chronic obstructive pulmonary disease (COPD), and initiation via vascular graft.
Conclusions:
- Patients over 80 starting hemodialysis exhibit higher mortality rates.
- Exacerbation of kidney disease, COPD, and vascular graft access are significant risk factors for mortality in this group.
Background:
The incidence of older patients over 80 years old with chronic kidney disease who start hemodialysis (HD) program has been increasing in the last decade.
Methods:
We aimed to identify risk factors for morbidity and mortality in patients older than 80 years with end-stage renal disease who started HD. We conducted a retrospective observational study of the Catalan Renal registry (RMRC).
Results:
A total of 2833 patients equal or older than 80 years (of 15,137) who started HD between 2002 and 2019 from the RMRC were included in the study. In this group, the first dialysis was performed through an arteriovenous fistula in 44%, percutaneous catheter in 28.2%, and tunneled catheter in 26.6%. Conventional dialysis was used in 65.7% and online HD in 34.3%. The most frequent cause of death was cardiac disease (21.8%), followed by social problems (20.4%) and infections (15.9%). Overall survival in older HD during the first year was 84% versus 91% in younger than 80 years (p < 0.001). Cox regression analysis identified the start of HD in the period 2002-2010, chronic obstructive pulmonary disease (COPD), and the onset of HD through vascular graft depicted as risk factors for first-year mortality after dialysis initiation in patients older than 80 years with end-stage renal disease who started HD.
Conclusions:
In conclusion, patients older than 80 years who started HD program had higher mortality, especially those who presented exacerbation of kidney disease, those with COPD, and those who started with a vascular graft.
Related Concept Videos
01:25Hemodialysis III: Nursing Management
01:24Hemodialysis II: Procedure and Complications
01:25Hemodialysis I: Introduction
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
01:25Peritoneal Dialysis III: Nursing Management