Is peritoneal dialysis suitable technique CKD patients over 65 years? A prospective multicenter study

Area of Science:

• Nephrology
• Geriatrics
• Internal Medicine

Background:

• Chronic kidney disease (CKD) prevalence is rising in older adults (>65 years), increasing morbidity and dependence.
• Peritoneal dialysis (PD) has traditionally been viewed as a treatment for younger, active patients.
• This study investigates PD suitability and outcomes in elderly CKD patients.

Purpose of the Study:

• To evaluate PD treatment and outcomes in patients over 65 years.
• To compare the results of PD in older patients versus younger patients (<65 years).
• To identify areas for improvement in PD therapy for elderly individuals.

Main Methods:

• Prospective, observational, multicenter study of incident PD patients from 2003-2018.
• Included 2,435 PD patients, with 31.9% aged over 65.
• Median follow-up was 2.1 years.

Main Results:

• Older patients (>65) had higher comorbidity (diabetes, CV events, Charlson index) but achieved similar PD adequacy and anemia management.
• Higher peritonitis rates were observed in older patients (0.65 vs 0.45 episodes/patient/year), without differences in germ types or admission rates.
• Mortality was higher in the >65 group (28.4% vs 9.4%), but PD permanence probability was similar; main withdrawal reasons were transplant (younger) and transfer to hemodialysis (older), often due to fatigue, not technique failure.

Conclusions:

• Patients over 65 successfully met PD adequacy criteria.
• PD is a valid therapeutic option for elderly patients with CKD.
• Preventing infections and patient/caregiver fatigue is crucial to avoid unnecessary transfers to hemodialysis.