FP362OUTCOME IN ELDERLY PATIENTS INCLUDED IN DIALYSIS PROGRAM

Abstract

Introduction and Aims: We assess outcome in patients older than 65 years (yrs) compared to patients younger than 65 yrs, incident in dialysis. Methods: We assessed 468 pts (males = 242, mean age = 56 ± 15.6 yrs) incident in dialysis between January 2009 ‐ January 2014, monitored for at least 6 months after dialysis start or until death. All pts were investigated at admission for uremia complications. Morbidity, mortality and causes of death were evaluated in pts ≥ 65 yrs age (elderly group ‐ EG) compared to pts < 65 yrs age (younger group ‐ YG). Results: 148 pts (31.6%) were ≥ 65 yrs, and 40 (10.3%) were ≥ 75 yrs. Referral vintage was lower in EG (13.7 ± 23.7 vs 17 ± 30.3 months). Hemodialysis (HD) was the preferred method in the EG (68.7%%), or in the YG (67.2%) pts. Central venous catheter (CVC) was used in 87 pts (59.2%) from EG, and in 172 pts (53.8%) from YG; AV fistula (AVF) was used in in 14 pts (9.5%) from EG, and in 43 pts (13.4%) from YG; peritoneal dialysis (PD) was used in in 46 pts (31.3%) from EG, and in 105 pts (32.8%) from YG. Elderly pts presented more frequent cardiac failure (51.4% vs 33.8%, p<0.05); arrhytmia (35.1% vs 18.4%, p<0.05), neurologial disturbances (26.6% vs 18.4%, p<0.05), while younger pts had more frequent uremic pericarditis (24.7% vs 14.9%, p<0.05). Mean values of biological parameters at dialysis initiation were similar between groups. General survival was significantly lower in elderly compared to younger pts (19.4 ± 23.2 months vs 52.4 ± 45.1 months, p<0.01). Although early mortality was similar between groups (6.4% vs 6.8% at 30 days, and 10.6% vs 9.1% at 90 days), we found significant differences at 6 months (23.6% vs 12.2%, p<0.01) and 12 months (28.7% vs 16.7%, p<0.01). Cox regression analysis identified the following factors influencing survival: age groups (elderly versus younger, p=0.016), presence of heart failure (p=0.0.37), hypoalbuminemia (p<0.0001) at dialysis initiation. Causes of death were mostly cardiovascular events in elderly pts (53.7% vs 33%, p<0.05), while sepsis (21.3% vs 9.3%, p<0.05) and neoplasia (12.8% vs 5.6%, p<0.05) were more frequent in younger pts . Survival was similar in elderly pts , stratified by dialysis procedure (17.7 ± 21.7 months in HD vs 20.7 ± 20.3 months in PD) or access type (16.4 ± 21.4 months for CVC vs 25.4 ± 22.6 months for AVF vs 20.7 ± 20.3 months for PD catheter) used for dialysis initiation. Conclusions: Elderly pts are referred later for nephrology care. Morbidity and mortality are higher in elderly compared to younger pts, and survival is lower, especially from cardiovascular causes. As regards the dialysis modality, elderly can benefit both from HD and PD procedures, similar to younger pts.