scholarly journals Trends in assisted peritoneal dialysis over the last decade: a cohort study from the French Peritoneal Dialysis Registry

2020 ◽  
Vol 13 (6) ◽  
pp. 1003-1011
Author(s):  
Annabel Boyer ◽  
Antoine Lanot ◽  
Mark Lambie ◽  
Sonia Guillouet ◽  
Thierry Lobbedez ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Prevalence Ratio ◽  
Economic Incentive ◽  
Economic Incentives ◽  
Limited Information ◽  
Calendar Time ◽  
The Impact ◽  
Assisted Peritoneal Dialysis ◽  
Over Time

Abstract Background There is limited information available on the use of assisted peritoneal dialysis (PD) over time and the impact of economic incentives on its utilization. The aim of this study was to describe the trends in assisted PD utilization and the type of assistance provided. We wanted to estimate if an economic incentive implemented in 2011 in France was associated with an increase in the utilization of nurse-assisted PD. Methods This retrospective, multicentre study, based on data from the French Language Peritoneal Dialysis Registry, analysed 11 987 patients who initiated PD in France between 1 January 2006 and 31 December 2015. Adjusted Cox regression with robust variance was used to examine the initiation of assisted PD, both nurse-assisted and family-assisted, accounting for the nonlinear impact of the PD starting time. Results There were 6149 (51%) incident patients on assisted PD, 5052 (82%) on nurse-assisted PD and 1097 (18%) on family-assisted PD over the study period. In the adjusted analysis, calendar time was associated with the assisted PD rate: it declined from 2008 until 2013 before flattening out and then it increased after 2014. Nurse-assisted PD utilization increased significantly after 2012, whereas family-assisted PD utilization decreased linearly over time (prevalence ratio = 0.94, 95% confidence interval 0.92–0.97). Conclusions The assisted PD rate decreased until 2013, mainly because of a decline in family-assisted PD. The uptake in nurse-assisted PD observed from 2013 reflects the effect of an economic incentive adopted in late 2011 to increase PD utilization.

scholarly journals Impact of the implementation of an assisted peritoneal dialysis service on peritoneal dialysis initiation

2020 ◽  
Vol 35 (9) ◽  
pp. 1595-1601
Author(s):  
Annabel Boyer ◽  
Ivonne Solis-Trapala ◽  
Matthew Tabinor ◽  
Simon J Davies ◽  
Mark Lambie
Keyword(s):  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Limited Information ◽  
Single Centre ◽  
Centre Study ◽  
Renal Replacement Therapies ◽  
Single Centre Study ◽  
The Impact ◽  
Assisted Peritoneal Dialysis ◽  
Over Time

Abstract Background There is limited information available on the impact that provision of an assisted peritoneal dialysis (PD) service has on the initiation of PD. The aim of this study was to assess this impact in a centre following initiation of assisted PD in 2011. Methods This retrospective, single-centre study analysed 1576 patients incident to renal replacement therapies (RRTs) between January 2002 and 2017. Adjusted Cox regression with a time-varying explanatory variable and a Fine and Gray model were used to examine the effect of assisted PD use on the rates and cumulative incidence of PD initiation, accounting for the non-linear impact of RRT starting time and the competing risks (transplant and death). Results Patients starting PD with assistance were older than those starting unassisted: median (interquartile range): 70.0 (61.5–78.3) versus 58.7 (43.8–69.2) years old, respectively. In the adjusted analysis assisted PD service availability was associated with an increased rate of PD initiation [cause-specific hazard ratio (cs-HR) 1.78, 95% confidence interval 1.21–2.61]. During the study period, the rate of starting PD fell before flattening out. Transplantation and death rates increased over time but this did not affect the fall in PD initiation [for each year in the study cs-HR of starting PD 0.95 (0.93–0.98), sub-distribution HR 0.95 (0.94–0.97)]. Conclusions In a single-centre study, introducing an assisted PD service significantly increased the rate of PD initiation, benefitting older patients most. This offsets a fall in PD usage over time, which was not explained by changes in transplantation or death.

Trends in Peritoneal Dialysis Technique Survival, Death, and Transfer to Hemodialysis: A Decade of Data from the RDPLF

2021 ◽  
pp. 1-10
Author(s):  
Annabel Boyer ◽  
Antoine Lanot ◽  
Mark Lambie ◽  
Christian Verger ◽  
Sonia Guillouet ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
French Language ◽  
Limited Information ◽  
Start Time ◽  
Calendar Time ◽  
Technique Survival ◽  
End Point ◽  
The Individual ◽  
Retrospective Multicenter Study ◽  
Over Time

<b><i>Introduction:</i></b> There is limited information on the trends of peritoneal dialysis (PD) technique survival over time. This study aimed to estimate the effect of calendar time on technique survival, transfer to hemodialysis (HD) (and the individual causes of transfer), and patient survival. <b><i>Methods:</i></b> This retrospective, multicenter study, based on data from the French Language Peritoneal Dialysis Registry, analyzed 14,673 patients who initiated PD in France between January 1, 2005, and December 31, 2016. Adjusted Cox regressions with robust variance were used to examine the probability of a composite end point of either death or transfer to HD, death, and transfer to HD, accounting for the nonlinear impact of PD start time. <b><i>Results:</i></b> There were 10,201 (69.5%) cases of PD cessation over the study period: 5,495 (37.4%) deaths and 4,706 (32.1%) transfers to HD. The rate of PD cessation due to death or transfer to HD decreased over time (PR 0.96, 95% CI: 0.95–0.97). Compared to 2009–2010, starting PD between 2005 and 2008 or 2011 and 2016 was strongly associated with a lower rate of transfer to HD (PR 0.88, 95% CI: 0.81–0.96, and PR 0.91, 95% CI: 0.84–0.99, respectively), mostly due to a decline in the rate of infection-related transfers to HD (PR 0.96, 95% CI: 0.94–0.98). <b><i>Conclusions:</i></b> Rates of the composite end point of either death or transfer to HD, death, and transfer to HD have decreased in recent decades. The decline in transfers to HD rates, observed since 2011, is mainly the result of a significant decline in infection-related transfers.

Impact of Assisted Peritoneal Dialysis Modality on Outcomes: A Cohort Study of the French Language Peritoneal Dialysis Registry

2018 ◽  
Vol 48 (6) ◽  
pp. 425-433 ◽  
Author(s):  
Solène Guilloteau ◽  
Thierry Lobbedez ◽  
Sonia Guillouët ◽  
Christian Verger ◽  
Maxence Ficheux ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Lower Risk ◽  
Regression Models ◽  
Cox Regression ◽  
French Language ◽  
Dialysis Modality ◽  
Technique Survival ◽  
Hazard Ratios ◽  
Effect Of Pd ◽  
Assisted Peritoneal Dialysis

Background: Patients on peritoneal dialysis (PD) can be assisted by a nurse or a family member and treated either by automated PD (APD) or continuous ambulatory PD (CAPD). The aim of this study was to evaluate the effect of PD modality and type of assistance on the risk of transfer to haemodialysis (HD) and on the peritonitis risk in assisted PD patients. Method: This was a retrospective study based on data from the French Language PD Registry. All adults starting assisted PD in France between 2006 and 2015 were included. Events of interest were transfer to HD, peritonitis and death. Cox regression models were used for statistical analysis. Results: Among the 12,144 incident patients who started PD in France during the study period, 6,167 were assisted. There were 5,060 nurse-assisted and 1,095 family-assisted PD patients. Overall, 5,171 were treated by CAPD and 996 by APD. In multivariate analysis, CAPD, compared to APD, was not associated with the risk of transfer to HD (cause specific hazard ratios [cs-HR] 0.96 [95% CI 0.84–1.09]). Patients on nurse-assisted PD had a lower risk of transfer to HD than family assisted PD patients (cs-HR 0.85 [95% CI 0.75–0.97]). Neither PD modality nor type of assistance were associated with peritonitis risk. Conclusions: In assisted PD, technique survival was not associated with PD modality. Nurse-assisted patients had a lower risk of transfer to HD than family assisted patients. Peritonitis risk was not influenced either by PD modality, or by type of assistance. Both APD and CAPD should be offered to assisted-PD patients.

Longitudinal Trends in Quality of Life and Physical Function in Frail Older Dialysis Patients: A Comparison of Assisted Peritoneal Dialysis and In-Center Hemodialysis

2019 ◽  
Vol 39 (2) ◽  
pp. 112-118 ◽  
Author(s):  
Osasuyi Iyasere ◽  
Edwina Brown ◽  
Fabiana Gordon ◽  
Helen Collinson ◽  
Richard Fielding ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Peritoneal Dialysis ◽  
Mixed Model ◽  
Rating Scale ◽  
Depression Scale ◽  
Dialysis Patients ◽  
The Impact ◽  
Assisted Peritoneal Dialysis

Background In-center hemodialysis (HD) has been the standard treatment for older dialysis patients, but reports suggest an associated decline in physical and cognitive function. Cross-sectional data suggest that assisted peritoneal dialysis (aPD), an alternative treatment, is associated with quality of life (QoL) outcomes that are comparable to in-center HD. We compared longitudinal changes in QoL between modalities. Methods We enrolled 106 aPD patients, matched with 100 HD patients from 20 renal centers in England and Northern Ireland. Patients were assessed quarterly for 2 years using the Hospital Anxiety and Depression Scale (HADS), SF-12 physical and mental scores, symptom score, Illness Intrusiveness Rating Scale (IIRS), Barthel's score, and the Renal Treatment Satisfaction Questionnaire (RTSQ). Mixed model analysis was used to assess the impact of dialysis modality on these outcomes during follow-up. P values were adjusted for multiple significance testing. Results Multivariate analysis showed no difference in any of the outcome measures between aPD and HD. Longitudinal trends in outcomes were also not significantly different. Higher age at baseline was associated with lower IIRS and RTSQ scores during follow-up. One-hundred and twenty-five (60.6%) patients dropped out of the study: 59 (28.6%) died, 61 (29.6%) withdrew during follow-up, and 5 (2.5%) were transplanted. Conclusions Quality of life outcomes in frail older aPD patients were equivalent to those receiving in-center HD. Assisted PD is thus a valid alternative to HD for older people with end-stage kidney disease (ESKD) wishing to dialyze at home.

scholarly journals Predictors of Peritonitis and the Impact of Peritonitis on Clinical Outcomes of Continuous Ambulatory Peritoneal Dialysis Patients in Taiwan—10 Years’ Experience in a Single Center

2014 ◽  
Vol 34 (1) ◽  
pp. 85-94 ◽  
Author(s):  
Yao-Peng Hsieh ◽  
Chia-Chu Chang ◽  
Yao-Ko Wen ◽  
Ping-Fang Chiu ◽  
Yu Yang
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Drop Out ◽  
Kaplan Meier ◽  
Underlying Mechanisms ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact ◽  
Technique Failure

ObjectivePeritoneal dialysis (PD) has become more prevalent as a treatment modality for end-stage renal disease, and peritonitis remains one of its most devastating complications. The aim of the present investigation was to examine the frequency and predictors of peritonitis and the impact of peritonitis on clinical outcomes.MethodsOur retrospective observational cohort study enrolled 391 patients who had been treated with continuous ambulatory PD (CAPD) for at least 90 days. Relevant demographic, biochemical, and clinical data were collected for an analysis of CAPD-associated peritonitis, technique failure, drop-out from PD, and patient mortality.ResultsThe peritonitis rate was 0.196 episodes per patient–year. Older age (>65 years) was the only identified risk factor associated with peritonitis. A multivariate Cox regression model demonstrated that technique failure occurred more often in patients experiencing peritonitis than in those free of peritonitis ( p < 0.001). Kaplan–Meier analysis revealed that the group experiencing peritonitis tended to survive longer than the group that was peritonitis-free ( p = 0.11). After multivariate adjustment, the survival advantage reached significance (hazard ratio: 0.64; 95% confidence interval: 0.46 to 0.89; p = 0.006). Compared with the peritonitis-free group, the group experiencing peritonitis also had more drop-out from PD ( p = 0.03).ConclusionsThe peritonitis rate was relatively low in the present investigation. Elderly patients were at higher risk of peritonitis episodes. Peritonitis independently predicted technique failure, in agreement with other reports. However, contrary to previous studies, all-cause mortality was better in patients experiencing peritonitis than in those free of peritonitis. The underlying mechanisms of this presumptive “peritonitis paradox” remain to be clarified.

scholarly journals Bleeding risk of haemodialysis and peritoneal dialysis patients

2020 ◽  
Vol 36 (1) ◽  
pp. 170-175
Author(s):  
Anita van Eck van der Sluijs ◽  
Alferso C Abrahams ◽  
Maarten B Rookmaaker ◽  
Marianne C Verhaar ◽  
Willem Jan W Bos ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Bleeding Risk ◽  
Time Dependent ◽  
Antiplatelet Drug ◽  
Dialysis Modality ◽  
Limited Information ◽  
Dialysis Patients ◽  
Cox Regression Analysis

Abstract Background Dialysis patients have an increased bleeding risk as compared with the general population. However, there is limited information whether bleeding risks are different for patients treated with haemodialysis (HD) or peritoneal dialysis (PD). From a clinical point of view, this information could influence therapy choice. Therefore the aim of this study was to investigate the association between dialysis modality and bleeding risk. Methods Incident dialysis patients from the Netherlands Cooperative Study on the Adequacy of Dialysis were prospectively followed for major bleeding events over 3 years. Hazard ratios with 95% confidence intervals (CIs) were calculated for HD compared with PD using a time-dependent Cox regression analysis, with updates on dialysis modality. Results In total, 1745 patients started dialysis, of whom 1211 (69.4%) received HD and 534 (30.6%) PD. The bleeding rate was 60.8/1000 person-years for HD patients and 34.6/1000 person-years for PD patients. The time-dependent Cox regression analysis showed that after adjustment for age, sex, primary kidney disease, prior bleeding, cardiovascular disease, antiplatelet drug use, vitamin K antagonist use, erythropoietin use, arterial hypertension, residual glomerular filtratin rate, haemoglobin and albumin levels, bleeding risk for HD patients compared with PD increased 1.5-fold (95% CI 1.0–2.2). Conclusions In this large prospective cohort of incident dialysis patients, HD patients had an increased bleeding risk compared with PD patients. In particular, HD patients with a history of prior bleeding had an increased bleeding risk.

scholarly journals Association between Dyslipidemia and Peritoneal Dialysis Technique Survival

2019 ◽  
Vol 7 (15) ◽  
pp. 2467-2473 ◽  
Author(s):  
Natalia Stepanova ◽  
Olena Burdeyna
Keyword(s):  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Large Body ◽  
Atherogenic Dyslipidemia ◽  
Future Research ◽  
Single Centre ◽  
Technique Survival ◽  
Atherogenic Lipid Profile ◽  
The Impact ◽  
Technique Failure

BACKGROUND: A large body of research has investigated the effects of pro-atherogenic lipid profile on cardiovascular diseases (CVD) in peritoneal dialysis (PD) patients. However, there is a general lack of research on the association between atherogenic dyslipidemia and PD technique survival. AIM: The study aimed to define the association between dyslipidemia and PD technique survival. METHODS: It was a prospective single-centre observational study involving 40 outpatients on continuous ambulatory PD treatment for more than 3 months between 2010 and 2016 in a single centre in Ukraine. There were 27 males and 13 females. The mean age of the participants was 49.3 ± 12.2 years. The primary outcome measures were all-cause technique failure. RESULTS: Atherogenic dyslipidemia was identified in 28/40 (70 %) patients and correlated with PD adequacy parameters. During the 36-month- follow-up period technique failure occurred in 2/12 (16.6 %) patients with atherogenic dyslipidemia compared with 12 / 28 (42.9 %) patients without atherogenic dyslipidemia (c2 = 2.5; p = 0.12). In the univariate Cox regression model, atherogenic dyslipidemia at baseline was significantly associated with a higher risk of all-cause PD technique failure (HR 4.5; 95% CI 1.6 to 12.9; c2 = 5.5, p = 0.019). CONCLUSION: The presence of atherogenic dyslipidemia was significantly associated with a higher risk of technique failure in PD patients. This is an important issue for future research. Further well-designed clinical trials are needed to determine the impact of dyslipidemia on PD adequacy and technique survival.

scholarly journals P1204PHROPHYLATIC GENTAMICIN - A THERAPEUTIC WEAPON IN THE COMBAT OF EXIT SITE INFECTIONS IN PERITONEAL DIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ana Abrantes ◽  
Francisco Ferrer ◽  
HernÂNi Ricardo Martins GonÇAlves ◽  
Ana Vila Lobos
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Demographic Data ◽  
Catheter Placement ◽  
Chronic Glomerulonephritis ◽  
Exit Site ◽  
Exit Site Infection ◽  
Cardiovascular Comorbidities ◽  
The Impact

Abstract Background and Aims Infection-related complications, such as exit-site infection (ESI) and peritonitis, are one of the main causes of technique failure and dropout in patients under peritoneal dialysis. Several studies have demonstrated the positive effect of daily topical antibiotics (AB) in preventing ESI. The aim of this study is to demonstrate the impact of topical gentamicin (TG) in preventing ESI, between 2009 and 2019, in a single-center of a medium-sized hospital in Portugal. Method Descriptive and retrospective analysis was performed. Demographic data, comorbidities, type of catheter placement and PD prescription were collected. For each patient, it was determined the time free of prophylactic AB (NTG) and under topical gentamicin (ophthalmic formula, once a day, applied on exit site). ESI cases were identify. Results Eighty-five patients were included, with a mean age of 53.2 ± 14.6 years; 69.5% were male. Cardiovascular comorbidities, like arterial hypertension and diabetes, were highly prevalent (88.2% and 76.5% respectively). Chronic glomerulonephritis and diabetes were the main causes of CKD (19; 22.4%; 15; 17.6%). More than 80% of the patients had previous Nephrology follow up. Percutaneous approach was the first option to catheter placement in 70.6% of the cases and DPA was performed in 53,0%. Every patient started the PD program free of prophylactic AB (n=85); 35 patients started TG at some point. Forty episodes of ESI were recorded, 39 (97.5%) in the NTG group. Staphylococcus aureus was the most frequently identified organism (16; 41.0%), followed by Staphylococcus epidermis (5; 12.5%) and Corynebacterium (5; 12.5%). The Kaplan-Meier analysis demonstrated that patients in TG were associated with better free-time of first peritonitis ((705 vs 985 days; p=0.001). The multivariate Cox regression model confirmed a 14 times higher risk of ESI in NTG group (HR 14.4; 95% CI 1.97-105.45; p=0.001). Conclusion Although mupirocin is still the first option in many centers, some studies have demonstrated a benefic role of gentamicin in reducing ESI, not only by Pseudomonas species but also Staphylococcus aureus. The results of our study confirmed that topical daily gentamicin is highly effective preventing ESI in PD patients. Despite of the concern with the gentamicin-resistant infections, just one patient developed ESI under gentamicin, and the identified microorganism was the Staphylococcus epidermidis.

scholarly journals An Inverse Relationship between Hyperuricemia and Mortality in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

2018 ◽  
Vol 7 (11) ◽  
pp. 416 ◽  
Author(s):  
Kuan-Ju Lai ◽  
Chew-Teng Kor ◽  
Yao-Peng Hsieh
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Cox Regression ◽  
Laboratory Data ◽  
Study Cohort ◽  
Dialysis Unit ◽  
Cox Regression Analysis ◽  
Hazard Ratios ◽  
Adjusted Model ◽  
The Impact

Background: The results have been inconsistent with regards to the impact of uric acid (UA) on clinical outcomes both in the general population and in patients with chronic kidney disease. The aim of this study was to study the influence of serum UA levels on mortality in patients undergoing continuous ambulatory peritoneal dialysis. Methods: Data on 492 patients from a single peritoneal dialysis unit were retrospectively analyzed. The mean age of the patients was 53.5 ± 15.3 years, with 52% being female (n = 255). The concomitant comorbidities at the start of continuous ambulatory peritoneal dialysis (CAPD) encompassed diabetes mellitus (n = 179, 34.6%), hypertension (n = 419, 85.2%), and cardiovascular disease (n = 186, 37.9%). The study cohort was divided into sex-specific tertiles according to baseline UA level. A Cox proportional hazard model was used to calculate hazard ratios (HRs) of all-cause, cardiovascular, and infection-associated mortality with adjustments for demographic and laboratory data, medications, and comorbidities. Results: Multivariate Cox regression analysis showed that, using UA tertile 1 as the reference, the adjusted HR of all-cause, cardiovascular, and infection-associated mortality for tertile 3 was 0.4 (95% confidence interval (CI) 0.24–0.68, p = 0.001), 0.4 (95% CI 0.2–0.81, p = 0.01), and 0.47 (95% CI 0.19–1.08, p = 0.1). In the fully adjusted model, the adjusted HRs of all-cause, cardiovascular, and infection-associated mortality for each 1-mg/dL increase in UA level were 0.84 (95% CI, 0.69–0.9, p = 0.07), 0.79 (95% CI, 0.61–1.01, p = 0.06), and 0.79 (95% CI, 0.48–1.21, p = 0.32) for men and 0.57 (95% CI, 0.44–0.73, p < 0.001), 0.6 (95% CI, 0.41–0.87, p = 0.006), and 0.41 (95% CI, 0.26–0.6, p < 0.001) for women, respectively. Conclusions: Higher UA levels are associated with lower risks of all-cause, cardiovascular and infection-associated mortality in women treated with continuous ambulatory peritoneal dialysis.

Abstract WP41: Age-Specific Differences in the Use of Endovascular Treatment and Hospital Outcomes in Patients With Acute Ischemic Stroke: A Community-Wide Perspective

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Iqra N Akhtar ◽  
Ameer E Hassan ◽  
Mohammad Rauf A Chaudhry ◽  
Mohsain Gill ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
International Classification Of Diseases ◽  
The United States ◽  
Primary Diagnosis ◽  
Limited Information ◽  
Hospital Outcomes ◽  
The Impact ◽  
Over Time

Background: Relatively limited information is available about trends over time in the use of endovascular treatment in patients of different ages hospitalized with acute ischemic stroke and the association between use of thrombectomy treatment and hospital outcomes in age strata. We performed this analysis to evaluate trends in the utilization of endovascular treatment in acute ischemic stroke by age strata in real-world practice. Methods: We conducted this study by identifying patients admitted with a primary diagnosis of ischemic stroke in the United States from 2007 to 2016 using the Nationwide Inpatient Sample. International Classification of Diseases, ninth revision, and tenth, Clinical Modification (ICD-9-CM, ICD-10-CM) codes were used to identify patients admitted for ischemic stroke and undergoing endovascular treatment. Results: Of the 4,590,533 patients admitted with ischemic stroke, 269,922 (5.88%) received intravenous thrombolytic treatment, and 51,375 (1.12%) underwent endovascular treatment. There is almost 12-fold significant increase in the use of endovascular treatment patients admitted with acute ischemic stroke between 2007 to 2016. Patients who were 75 years and older experienced a marked increase in the receipt of endovascular treatment over time (0.12% 2007; 1.91% 2016; trend p<0.0001). We observed statistically significant improvement in outcomes including minimal disability (6.3% to 18.8%; trend p<0.0001) and in hospital mortality (25.0% to 16.5%; trend p<0.0001) in patients 75 years and older treated with endovascular treatment in study period. We observed similar trend of outcomes in each of the other age-specific groups under study (<55, 55-64 and 65-74 years). Conclusions: Our findings indicate a recent increase in the use of endovascular in middle-aged and elderly patients with acute ischemic strokes. The impact of endovascular treatment on hospital outcomes was observed in each of our age strata understudy though the magnitude of absolute and relative benefit varied according to age.

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