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Prognostic markers in older patients starting renal replacement therapy
S V Jassal1, J F Douglas, R W Stout
1Department of Geriatric Medicine, Queen's University of Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, BT9 7BL, UK.
Aims:
We assessed all patients starting renal replacement therapy during a 1-year period to identify factors influencing 1-year survival in older and younger dialysis patients.
Methods:
Data was collected from 113 patients. Twenty-four possible prognostic factors were introduced into a multivariate, time-based analysis.
Results:
Hazard ratios, and hence risk of mortality, were increased with increasing alcohol consumption, cardiac dyskinesis, age at onset of dialysis, serum phosphate, number of comorbid illnesses, and Karnofsky score (listed in decreasing order of risk). Risk of death within 1 year was reduced in patients with normal serum albumin and higher Barthel scores at the time of commencing dialysis. No age interactions were found. In the elderly age group the risk of death was also increased if left ventricular dilatation was present. Comorbidity and the age of onset were not independent risk factors in patients aged over 65 years at the time of starting dialysis.
Conclusions:
All factors listed above increase the 1-year mortality of elderly patients. Factors known to increase medium-term morbidity in dialysis patients including diabetes mellitus, ischaemic heart disease, and hypertension do not appear to be important in the short-term survival of older patient on dialysis.