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Dialysis modality and survival in octogenarians: real-world population-based cohort study
Néstor Toapanta1, María Antonieta Azancot1, Jordi Comas2
1Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, Autonomous University of Barcelona, Barcelona, Spain.
Clinical Kidney Journal
|August 7, 2026
Summary
For octogenarians starting kidney replacement therapy, initial dialysis modality (hemodialysis vs. peritoneal dialysis) did not impact survival. However, switching from peritoneal dialysis to hemodialysis was linked to increased mortality risk.
Area of Science:
- Nephrology
- Geriatric Medicine
- Public Health
Background:
- Limited evidence exists for dialysis modality selection in very elderly patients.
- Real-world outcomes for octogenarians initiating kidney replacement therapy (KRT) are poorly understood.
Purpose of the Study:
- To evaluate long-term survival based on initial dialysis modality in octogenarians.
- To analyze the impact of modality switching on survival in this age group.
Main Methods:
- A population-based cohort study using the Catalan Renal Registry (2000-2022).
- Identified octogenarians (≥80 years) initiating dialysis (hemodialysis [HD] vs. peritoneal dialysis [PD]).
- Propensity score-matched analysis (1:3 ratio) and Cox proportional hazards models with time-dependent covariates for modality switching.
Main Results:
- Among 4205 octogenarians, 239 initiated PD and 3966 initiated HD.
- After matching, 5-year survival did not differ significantly between initial PD and HD groups.
- Switching from PD to HD was independently associated with increased mortality (HR 1.46; P=.038).
Conclusions:
- Initial dialysis modality choice (PD vs. HD) does not significantly affect survival in octogenarians.
- Transitioning from PD to HD is linked to higher mortality, highlighting the need for careful monitoring.
- Older age and earlier KRT initiation (2000-07) were associated with poorer outcomes.
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