Predialysis Nephrology Care of Older Patients Approaching End-stage Renal Disease

Abstract Background and Aims Over the last decade, the age of dialysis patients has been increasing steadily worldwide. The benefits of dialysis in older people with end stage renal disease (ESRD) are not clear. We will try to evaluate whether dialysis in older has survival advantage compared to younger people. Method It is a prospective descriptive and analytic study including 229 patients who initiated chronic hemodialysis during the period between January and June 2017. Patients were classified into two groups by age at dialysis initiation. Patients above 75 years of age were considered old (old group OG). Patients aged less then 75 years old were considered young (young group YG). Primary outcome was old patient’s survival during the first 3 and 12 months from the dialysis initiation. Results Among a total of 229 new patients who began dialysis treatment, 41 (17,9%) ESRD were above 75 years of age.The sex ratio was 0,95 and 1,54 in respectively in OG and YG (p = 0,167). Diabetes was present in 56% of the elderly and in 59% of the younger group (p = 0,72) and was more frequently the cause of ESRD in the two groups. The average of modified Charlson Comorbidity Index was 6,7 ± 2,3 and 3,9 ± 2,6 respectively in OG and YG(p = 10-3). Younger patients had been referred earlier to nephrologists than the older ones. In fact, glomerular filtration rate at the beginning of the follow up was 18,7 ± 8,9 ml/min/1,73 in OG and 25,4 ± 16,2 in YG (p = 0,004). There was no statically significant difference between the two groups in the frequency of the use of temporary catheters at dialysis initiation (p = 0,778) and the urgent or planned initiation of dialysis (p = 0,298). Younger patients required hospitalization to organize dialysis initiation more than older patients (51,6% VS 26,8%; p = 0,005). Compared with the group of younger patients, Cox model showed an incremental increase in mortality associated with older patients’ group during the first year of HD (p = 0,036). However, there was no difference between OG and YG in the mortality rate during the first 3 months of HD (p = 0,102). Conclusion We may conclude that life expectancy of patients who began dialysis above 75 years is significantly shorter than younger patients in the first year of HD. In the other hand, the difference between the 2 groups wasn’t significant regarding the conditions of dialysis initiation.

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Effects of Early Frequent Nephrology Care on Emergency Department Visits among Patients with End-stage Renal Disease

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16071158 ◽

2019 ◽

Vol 16 (7) ◽

pp. 1158

Author(s):

Yun-Yi Chen ◽

Likwang Chen ◽

Jenq-Wen Huang ◽

Ju-Yeh Yang

Keyword(s):

Emergency Department ◽

Renal Disease ◽

End Stage Renal Disease ◽

Lower Risk ◽

Early Referral ◽

Dialysis Treatment ◽

Nephrology Care ◽

Stage Renal Disease ◽

End Stage ◽

Late Referral

In this retrospective cohort study, we examined the association between predialysis nephrology care status and emergency department (ED) events among patients with end-stage renal disease. Data pertaining to 76,702 patients who began dialysis treatment between 1999 and 2010 were obtained from the National Health Insurance Research Database of Taiwan (NHIRD). The patients were divided into three groups based on the timing of the first nephrology care visit prior to the initiation of maintenance dialysis, and the frequency of nephrologist visits (i.e., early referral/frequent consultation, early referral/infrequent consultation, late referral). At 1-year post-dialysis initiation, a large number of the patients had experienced at least one all-cause ED visit (58%), infection-related ED visit (17%), or potentially avoidable ED visit (7%). Cox proportional hazard models revealed that patients who received early frequent care faced an 8% lower risk of all-cause ED visit (HR: 0.92; 95% CI: 0.90–0.94), a 24% lower risk of infection-related ED visit (HR: 0.76; 95% CI: 0.73–0.79), and a 24% lower risk of avoidable ED visit (HR: 0.76; 95% CI: 0.71–0.81), compared with patients in the late referral group. With regard to the patients undergoing early infrequent consultations, the only marginally significant association was for infection-related ED visits. Recurrent event analysis revealed generally consistent results. Overall, these findings indicate that continuous nephrology care from early in the predialysis period could reduce the risk of ED utilization in the first year of dialysis treatment.

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Trends in Anemia Care in Older Patients Approaching End-Stage Renal Disease in the United States (1995-2010)

JAMA Internal Medicine ◽

10.1001/jamainternmed.2014.87 ◽

2014 ◽

Vol 174 (5) ◽

pp. 699 ◽

Cited By ~ 10

Author(s):

Wolfgang C. Winkelmayer ◽

Aya A. Mitani ◽

Benjamin A. Goldstein ◽

M. Alan Brookhart ◽

Glenn M. Chertow

Keyword(s):

United States ◽

Renal Disease ◽

End Stage Renal Disease ◽

Older Patients ◽

The United States ◽

Stage Renal Disease ◽

End Stage

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Physician access and early nephrology care in elderly patients with end-stage renal disease

Kidney International ◽

10.1038/ki.2008.212 ◽

2008 ◽

Vol 74 (12) ◽

pp. 1596-1602 ◽

Cited By ~ 7

Author(s):

Yongming Zhao ◽

John M. Brooks ◽

Michael J. Flanigan ◽

Elizabeth A. Chrischilles ◽

Jane F. Pendergast ◽

...

Keyword(s):

Elderly Patients ◽

Renal Disease ◽

End Stage Renal Disease ◽

Nephrology Care ◽

Stage Renal Disease ◽

End Stage

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Epidemiology of dialysis-treated end-stage renal disease patients in Kazakhstan: data from nationwide large-scale registry 2014–2018

BMC Nephrology ◽

10.1186/s12882-020-02047-6 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Abduzhappar Gaipov ◽

Alpamys Issanov ◽

Kainar Kadyrzhanuly ◽

Dinara Galiyeva ◽

Marina Khvan ◽

...

Keyword(s):

Mortality Rate ◽

Renal Disease ◽

Survival Probability ◽

End Stage Renal Disease ◽

Older Patients ◽

Large Scale ◽

Dialysis Patients ◽

Risk Of Death ◽

Stage Renal Disease ◽

End Stage

Abstract Background The epidemiology of dialysis patients has been little studied in developing countries and economies in transition. We examined the prevalence, incidence and mortality rate of dialysis patients in Kazakhstan, via aggregation and utilization of large-scale administrative healthcare data. Methods The registry data of 8898 patients receiving dialysis therapy between 2014 and 2018 years were extracted from the Unified National Electronic Health System (UNEHS) and linked with the national population registry of Kazakhstan. We provide descriptive statistics of demographic, comorbidity and dialysis-related characteristics. Results Among all patients undergoing maintenance dialysis for end-stage renal disease (ESRD), there were 3941 (44%) females and 4957 (56%) males. 98.7% of patients received hemodialysis and 1.3% peritoneal dialysis. The majority of the patients (63%) were ethnic Kazakhs, 18% were Russians and 19% were of other ethnicities. The prevalence and incidence rate in 2014 were 135.2 and 68.9 per million population (PMP), respectively, which were different in 2018 [350.2 and 94.9 PMP, respectively]. Overall mortality rate among dialysis patients reduced from 1667/1000 patient-years [95%Confidence Interval (CI): 1473–1886] (PY) in 2014 to 710/1000PY [95%CI: 658–767] in 2018. We observed 13% lower crude survival probability in females compared to males and in older patients compared to younger ones. Russian ethnicity had 58% higher risk of death, while other ethnicities had 34% higher risk of death compared to in those of Kazakh ethnicity. Conclusion We describe for the first time in Kazakhstan an increase in the prevalence and incidence of ESRD on dialysis, while mortality rate decreased over time, during 2014–2018. We observed statistically significant lower survival probability in female dialysis patients compared to males, in older patients compared to younger ones, and in patients of Russian ethnicity compared to Kazakh.

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Effects of dialysis modality choice on the survival of end-stage renal disease patients in southern China: a retrospective cohort study

BMC Nephrology ◽

10.1186/s12882-020-02070-7 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Zhiren He ◽

Haijing Hou ◽

Difei Zhang ◽

Yenan Mo ◽

La Zhang ◽

...

Keyword(s):

Cohort Study ◽

Renal Disease ◽

Retrospective Cohort Study ◽

End Stage Renal Disease ◽

Older Patients ◽

Retrospective Cohort ◽

Risk Of Death ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Abstract Background The optimal choice of treatment, with hemodialysis (HD) or peritoneal dialysis (PD), for end-stage renal disease (ESRD) patients, is still controversial. Only a few studies comparing HD and PD have been conducted in China, which has the largest number of dialysis patients in the world. Methods A retrospective cohort study was conducted on ESRD patients who began renal replacement treatment from January 1, 2012 to December 31, 2017 in Guangdong Provincial Hospital of Chinese Medicine. Propensity scoring match was applied to balance the baseline conditions and multivariate Cox regression analysis to compare the mortality between HD and PD patients, and evaluated the correlation between mortality and various baseline characteristics. Results A total of 436 HD patients and 501 PD patients were included in this study, and PD patients had better survival than HD patients, but the difference was not statistically significant. For younger ESRD patients (≤60-year-old), the overall survival of PD was better than that of HD, but HD was associated with a lower risk of death in older patients (> 70-year-old). This difference was still significant after adjustment for a variety of confounding factors. Female gender, age at dialysis initiation, cardiovascular disease, cholesterol, and HD were risk factors of all-cause mortality in the younger subgroup, while PD was risk factor in the older subgroup. Conclusion PD may be a better choice for younger ESRD patients, and HD for the older patients.

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