Impact of the management of advanced kidney disease in patients over 80 years of age: a multicenter Spanish study.

Abstract

Background: The decision to initiate kidney replacement therapy (KRT) rather than conservative care in patients with chronic kidney disease (CKD) depends on various factors and carries significant consequences. This study analyzes the impact of choice of treatment modality on hospitalization and survival of very old patients with advanced CKD.

Methods: This multicenter, retrospective, observational study analyzed data collected from 11 spanish hospital between 2019 and 2022. The study included patients aged over 80 years with an estimated glomerular filtration rate (eGFR) of less than 15 mL/min/1.73 m2. Baseline epidemiological data and information on comorbidities were collected. The factors associated with the choice of conservative treatment, as well as its impact on hospitalization and survival were analyzed. A sub-analysis was performed comparing patients with a survival time of less than one year.

Results: Four hundred ninety-two patients (58.1% male, age 85 ± 4 years) were included. Among them, 262 (53.3%) opted for conservative care, while 230 (46.7%) initiated KRT, of whom 74 (32.1%) did so urgently. Factors independently associated with choosing conservative care were female sex, older age, higher eGFR, and greater level of dependency (all P < .001). During follow-up (21 [13-34] months), 221 patients (44.9%) died. Choosing conservative care was independently associated with mortality (Hazard Ratio [HR] 2.554, P < .001). There was a trend towards an association between urgent initiation of KRT and mortality compared to programmed KRT (HR 2.064, P = .080). In patients surviving less than 12 months, conservative care and KRT exhibited similar outcomes.

Conclusions: In very old patients, KRT is associated with better survival than conservative care. However, urgent initiation of KRT or short expected survival reduces the prognostic benefits.