P1541HEMODIALYSIS IN END-STAGE RENAL DISEASE PATIENTS OVER 75 YEARS OLD

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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The Profile of Timing Dialysis Initiation in Patients with End-stage Renal Disease in China: A Cohort Study

Kidney & Blood Pressure Research ◽

10.1159/000504671 ◽

2020 ◽

Vol 45 (2) ◽

pp. 180-193

Author(s):

Ying Liu ◽

Luping Wang ◽

Xianfeng Han ◽

Yang Wang ◽

Xuefeng Sun ◽

...

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Cox Regression ◽

Mainland China ◽

Dialysis Initiation ◽

Significant Difference ◽

Initiation Of Dialysis ◽

Stage Renal Disease ◽

End Stage ◽

The Relationship

Background: Hemodialysis is the main approach for renal replacement therapy in patients with end-stage renal disease (ESRD) in China. The timing of dialysis initiation is one of the key factors influencing patient survival and prognosis. Over the past decade, the relationship between the timing of dialysis initiation and mortality has remained unclear in patients with ESRD in China. Methods: Patients who commenced maintenance hemodialysis from 2009 to 2014 from 24 hemodialysis centers in Mainland China were enrolled in the study (n = 1,674). Patients were divided into 2 groups based on the year they started hemodialysis (patients who started hemodialysis from 2009 to 2011, and patients who started hemodialysis from 2012 to 2014). Analysis of the yearly change in the estimated glomerular filtration rate (eGFR) at the initiation of dialysis was performed for the 2 groups. Meanwhile, the patients were divided into 3 groups based on their eGFR at the initiation of dialysis (<4, 4–8, and >8 mL/min/1.73 m2). For these 3 groups, the relationship between the eGFR at the start of dialysis and mortality were analyzed. Results: The average eGFRs were 5.68 and 5.94 mL/min/1.73 m2 for 2009–2011 and 2012–2014, respectively. Compared with the 2009–2011 group, the proportion of patients with diabetes in 2012–2014 increased from 26.7 to 37.7%. The prognosis of patients with different eGFRs at the start of dialysis was analyzed using Kaplan-Meier survival curves. After adjusting for confounding factors through a Cox regression model, no significant difference was demonstrated among the 3 groups (<4 mL/min/1.73 m2 was used as the reference, in comparison with 4–8 mL/min/1.73 m2 [p = 0.681] and >8 mL/min/1.73 m2 [p = 0.403]). Conclusion: In Mainland China, the eGFR at the start of dialysis did not change significantly over time from 2008 to 2014 and had no association with the mortality of patients with ESRD.

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Patient Survival Between Hemodialysis and Peritoneal Dialysis Among End-Stage Renal Disease Patients Secondary to Myeloperoxidase-ANCA-Associated Vasculitis

Frontiers in Medicine ◽

10.3389/fmed.2021.775586 ◽

2022 ◽

Vol 8 ◽

Author(s):

Xueqin Wu ◽

Yong Zhong ◽

Ting Meng ◽

Joshua Daniel Ooi ◽

Peter J. Eggenhuizen ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Renal Disease ◽

End Stage Renal Disease ◽

Patient Survival ◽

Dialysis Initiation ◽

Dialysis Modality ◽

Significant Difference ◽

Stage Renal Disease ◽

End Stage

BackgroundA significant proportion of anti-neutrophil cytoplasmic antibody (ANCA) associated glomerulonephritis eventually progresses to end-stage renal disease (ESRD) thus requiring long-term dialysis. There is no consensus about which dialysis modality is more recommended for those patients with associated vasculitis (AAV-ESRD). The primary objective of this study was to compare patient survival in patients with AAV-ESRD treated with hemodialysis (HD) or peritoneal dialysis (PD).MethodsThis double-center retrospective cohort study included dialysis-dependent patients who were treated with HD or PD. Clinical data were collected under standard format. The Birmingham vasculitis activity score (BVAS) was used to evaluate disease activity at diagnosis and organ damage was assessed using the vasculitis damage index (VDI) at dialysis initiation.ResultsIn total, 85 patients were included: 64 with hemodialysis and 21 with peritoneal dialysis. The patients with AAV-PD were much younger than the AAV-HD patients (48 vs. 62, P < 0.01) and more were female (76.2 vs. 51.6%, P = 0.05). The laboratory data were almost similar. The comorbidities, VDI score, and immuno-suppressive therapy at dialysis initiation were almost no statistical difference. Patient survival rates between HD and PD at 1 year were 65.3 vs. 90% (P = 0.062), 3 year were 59.6 vs. 90% (P < 0.001), and 5 years were 59.6 vs. 67.5% (P = 0.569). The overall survival was no significant difference between the two groups (P = 0.086) and the dialysis modality (HD or PD) was not shown to be an independent predictor for all-cause death (hazard ratio (HR) 0.73; 95% confidence interval (CI) 0.31–1.7; P = 0.473). Cardio-cerebrovascular events were the main cause of death among AAV-HD patients while infection in patients with AAV-PD.ConclusionThese results provide real-world data that the use of either hemodialysis or peritoneal dialysis modality does not affect patient survival for patients with AAV-ESRD who need long-term dialysis.

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Treatment Choice and Outcomes for End Stage Renal Disease: Evidence from the First Year of a Nationwide Randomized Evaluation

AEA Randomized Controlled Trials ◽

10.1257/rct.8034-1.0 ◽

2021 ◽

Author(s):

Amy Finkelstein

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Treatment Choice ◽

First Year ◽

Randomized Evaluation ◽

Stage Renal Disease ◽

End Stage

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Quality of Care in Chronic Kidney Disease and Incidence of End-Stage Renal Disease in Older Patients

Medical Care ◽

10.1097/mlr.0000000000001301 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Shingo Fukuma ◽

Tatsuyoshi Ikenoue ◽

Sayaka Shimizu ◽

Edward C. Norton ◽

Rajiv Saran ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Quality Of Care ◽

Kidney Disease ◽

Renal Disease ◽

End Stage Renal Disease ◽

Older Patients ◽

Stage Renal Disease ◽

End Stage

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The Success Story of Peritoneal Dialysis in Romania: Analysis of Differences in Mortality by Dialysis Modality and Influence of Risk Factors in a National Cohort

Peritoneal Dialysis International ◽

10.1177/089686080602600224 ◽

2006 ◽

Vol 26 (2) ◽

pp. 266-275 ◽

Cited By ~ 14

Author(s):

Gabriel Mircescu ◽

Liliana Garneata ◽

Laura Florea ◽

Vasile Cepoi ◽

Dimitrie Capsa ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Renal Disease ◽

End Stage Renal Disease ◽

Comorbid Conditions ◽

Cox Regression Analysis ◽

Risk Of Death ◽

Significant Difference ◽

Stage Renal Disease ◽

End Stage

Background This report describes the status of renal replacement therapy (RRT), particularly continuous ambulatory peritoneal dialysis (CAPD), in Romania (a country with previously limited facilities), outlines the fast development rate of CAPD, and presents national changes in a European context. Methods Trends in the development of RRT were analyzed in 2003 on a national basis using annual center questionnaires from 1995 to 2003. Survival data and prognostic risk factors were calculated retrospectively from a representative sample of 2284 patients starting RRT between 1 January 1995 and 31 December 2001 (44% of the total RRT population investigated). Results The annual rate of increase in the number of RRT patients (11%) was supported mainly by an exponential development of the CAPD population (+600%); the hemodialysis (HD) growth rate was stable (+33%) and renal transplantation had a marginal contribution. The characteristics of both HD and PD incident patients changed according to current European epidemiology (increasing age and prevalence of diabetes and nephroangiosclerosis). There were significant differences between PD and HD incident populations, PD patients being significantly older and having a higher prevalence of diabetic nephropathy and baseline comorbidities, probably reflecting different inclusion policies. The estimated overall survival of RRT patients in Romania was 90.6% at 1 year [confidence interval (CI) 89.4 – 91.8] and 62.2% at 5 years (CI 59.4 – 65.0). The initial treatment modality did not significantly influence patients’ survival. There was no difference in unadjusted technique survival during the first 2 years; afterwards, there was a clear advantage for HD, with more patients being transferred from PD to HD. Several factors seemed to significantly and negatively influence PD patients’ survival (Cox regression analysis): male gender, lack of predialysis erythropoietin treatment, and initial comorbidities. Stratified analysis to discover the influence of these factors on patients’ survival revealed that HD was associated with an increased risk of death in the younger nondiabetic end-stage renal disease population, regardless of other coexisting comorbid conditions. However, in older patients (>65 years) and in diabetics, regardless of the presence or absence of associated comorbid conditions, there was no significant difference in death rates between HD and PD patients. Conclusions We report an impressive quantitative and qualitative development of CAPD in one of the rapidly growing Central and Eastern Europe countries. CAPD should be the method of choice for young nondiabetic end-stage renal disease patients. Improvement in predialysis nephrologic care and in transplantation rates is required to further ensure the ultimate success of the Romanian PD program.

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

Yearbook of Medicine ◽

10.1016/j.ymed.2011.09.027 ◽

2011 ◽

Vol 2011 ◽

pp. 245-248

Author(s):

R. Garrick

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Older Patients ◽

Nephrology Care ◽

Stage Renal Disease ◽

End Stage

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

Archives of Internal Medicine ◽

10.1001/archinternmed.2011.360 ◽

2011 ◽

Vol 171 (15) ◽

pp. 1371 ◽

Cited By ~ 42

Author(s):

Wolfgang C. Winkelmayer

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Older Patients ◽

Nephrology Care ◽

Stage Renal Disease ◽

End Stage

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Reviews and Original Articles Lipoprotein(A) and Apolipoprotein(A) Phenotypes in Patients with End-Stage Renal Disease

Peritoneal Dialysis International ◽

10.1177/089686089701700305 ◽

1997 ◽

Vol 17 (3) ◽

pp. 236-242 ◽

Cited By ~ 7

Author(s):

Soon Bae Kim ◽

Won Seok Yang ◽

Eun Suk Kang ◽

Won Ki Min ◽

Jung Sik Park

Keyword(s):

Molecular Weight ◽

Renal Disease ◽

Serum Albumin ◽

High Molecular Weight ◽

End Stage Renal Disease ◽

Lipoprotein A ◽

Apolipoprotein A ◽

Significant Difference ◽

Stage Renal Disease ◽

End Stage

Objective To evaluate the distribution pattern of apolipoprotein(a) [Apo(a)] phenotypes in Koreans and the effect of dialysis modality on serum lipoprotein(a) [Lp(a)] concentration according to apo(a) phenotype in patients with end-stage renal disease (ESRO). Design Cross-sectional study. Setting A university hospital. Participants: 153 normal controls, 99 hemodialysis (HO) patients and 82 continuous ambulatory peritoneal dialysis (CAPO) patients. Main Outcome Measures Fasting serum Lp(a), lipids, and apo(a) phenotypes were measured. Results The frequencies of the subjects with apo(a) phenotypes of high-molecular weight only, including S3, S4, or S5 or null type were 95.4% of control, 100% of HO patients, and 95.1% of CAPO patients. The frequent apo(a) phenotypes in Koreans consisted of S4, S4S5, S5, and S5S5 isoforms. Significant difference was found in serum Lp(a) concentration among controls and HO and CAPO patients [median (interquartile range): 0.05 g/L, (0.01 0.19); 0.19g/L, (0.10 0.35); 0.63g/L, (0.28 0.90), p< 0.001]. Lp(a) levels in CAPO patients were significantly higher than in HO patients for all four common apo(a) isoforms found in Korean subjects. CAPO patients had higher total and LOL cholesterol levels, and higher ApoB levels than H O patients. Significant differences were found in serum albumin levels between controls and HO and CAPO patients (44 ± 3 g/L, 40 ± 4 g/L, 32 ± 7 g/L, respectively, p < 0.05). There were significant inverse correlations between serum albumin and Lp(a) (r = -0.33, p < 0.01), total cholesterol (r = -0.31, p < 0.01), LOL (r = -0.39, p < 0.01) or ApoB (r = -0.35, p < 0.01) in ESRO patients. A significant positive correlation was found between serum albumin and ApoA1 (r = 0.24, p < 0.01). Conclusion These findings indicate that Koreans have mainly high -molecular weight apo(a) phenotypes and serum Lp(a) is elevated in CAPO patients compared to HO patients for common apo(a) phenotypes, which may contribute to the frequent cardiovascular mortality in CAPO patients.

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