Outcomes in elderly patients with end-stage renal disease: Comparison of renal replacement therapy and conservative management

Background/purpose

With global socioeconomic development and improvement in the general health care system, life expectancy increases, resulting in an increasing incidence of end-stage renal disease in the elderly population. We compared the survival rate in elderly patients aged ≥ 65 years with Stage 5 chronic kidney disease, managed with either renal replacement therapy (RRT) or conservative treatment. We also tried to identify factors associated with survival in these two groups.

Methods

This is a single-center retrospective study of patients aged ≥ 65 years with Stage 5 chronic kidney disease, who were referred to the nephrology team for renal advance care planning to assist in decision making for RRT or conservative treatment from 2005 to 2013. They were followed up till death or till December 31, 2014. Baseline characteristics (demographics, clinical data, functional status, socioeconomic factors, and laboratory parameters) and mortality data between the two groups were compared.

Results

A total of 558 patients were recruited during the study period, in which 126 (22.6%) patients opted for RRT and 432 (77.4%) for conservative treatment. Patients with less significant comorbidities, lower modified Charlson's Comorbidity Index scores, better functional and mental statuses, as well as better socioeconomic status were more likely to choose RRT. The RRT group had a longer median survival of 44.6 months compared with 10.0 months in the conservative treatment group. The survival advantage of the RRT group was lost in patients older than 85 years, or in those with high comorbidity (modified Charlson's Comorbidity Index score of ≥11) or dependent mobility. Age, comorbidity, and mobility were predictors of mortality in the RRT group. For the conservative group, age, mobility, and sex were predictors of mortality.

Conclusion

Elderly patients with end-stage renal disease can be benefited from RRT. However, the survival advantage of RRT was lost in very-advanced-age patients older than 85 years of age, in those with high comorbidity, or in functionally dependent patients.

目的

在全球性的社會經濟發展下;預期壽命得以延長;導致在老年人口中;末期腎病的發生率亦有所增長。我們在 ≥ 65 歲的第 5 期慢性腎病年老患者間;比較了腎置換療法 (RRT) 與保守療法所達到的存活率。同時;我們亦嘗試找出影響這兩組病人存活的因素。

方法

這是一項單中心的回溯性研究;對象為 ≥ 65 歲的第 5 期慢性腎病患者。他們是在 2005 年至 2013 年期間;被轉介至腎科團隊接受預設照顧計劃;以協助他們選擇 RRT 或保守療法；追蹤期至 2014 年 12 月 31 日或病人去世為止。我們比較了兩組病人的基線特徵及死亡率數據。

結果

本研究共納入 558 位病人;其中 126 (22.6%) 人選擇了 RRT;432 (77.4%) 人選擇了保守療法。RRT 組的存活中位數為 44.6 個月;較保守療法組的 10.0 個月長。然而;在 >85 歲、共病顯著 (mCCI ≥ 11)、或不能獨立行動的病人中;RRT 的存活優勢消失。在 RRT 組中;年齡、共病、及行動力是死亡的預測因子,在保守療法組中;年齡、行動力、及性別是死亡的預測因子。

結論

年老末期腎病患者可以獲益於 RRT,然而;在 >85 歲的極高齡者、共病顯著者、或不能獨立行動的病人中;RRT 的存活優勢不復存在。