Hospitalizations in Octogenarian Patients with End-Stage Renal Disease: What Changes after Beginning of Hemodialysis?

Abstract

Introduction: The benefits of dialysis in the octogenarian are dubious. This study aimed to investigate whether initiation of chronic hemodialysis (HD) changes the rate and duration of hospitalizations in a Portuguese cohort of octogenarian patients. Material and methods: A single-centre, retrospective, observational study was performed. Patients aged ≥ 80 years who initiated HD in a Portuguese Central Hospital between January 2007 and December 2017 were screened for inclusion. Hospitalizations in the 2-year period before HD initiation were compared to the first 2 years after starting HD. McNemar and Wilcoxon signed rank test were used. Results: A total of 88 patients were included, with a mean age of 84 ± 2.8 years. Nearly all the patients (97.7%) had one or more comorbid conditions. In 60.2% of the patients the functional activity was normal (Karnofsky score ≥ 80). Hemodialysis was initiated in an emergency situation in 58% of the patients and the majority (59.1%) had an arteriovenous fistula as vascular access. In the pre-HD period, most patients (54.5%) had at least one hospitalization (min = 1; max = 4). After HD started, the number of hospitalizations decreased ( p = 0.034) and only 39.8% of the patients required hospital admission (min = 1; max = 3), with shorter average hospital stay ( p = 0.013). Conclusion: The number and length of hospitalizations did not increase with the beginning of HD