Abstract: FR-PO940

Outcomes in Dialysis versus Conservative Care for Older Patients: A Prospective Cohort Analysis of Stage 5 CKD

Session Information

  • Geriatric Nephrology
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Geriatric Nephrology

  • 901 Geriatric Nephrology

Authors

  • Raman, Maharajan, Salford Royal NHS Foundation Trust, Salford, United Kingdom
  • Kalra, Philip A., Salford Royal NHS Foundation Trust, Salford, United Kingdom
  • Green, Darren, Salford Royal NHS Foundation Trust, Salford, United Kingdom
Background

The benefits of dialysis in older people with ESKD are not clear. We aimed to establish whether dialysis has survival advantage compared to conservative care (CC) in older people who were medically suitable for dialysis therapy.

Methods

This was a prospective observational study of CKD patients aged ≥75 years when eGFR first reached ≤15ml/min/1.73m2 . Estimates of median survival and hazard ratios (HR) for death were compared between patients who chose dialysis versus those who chose conservative care from two time points: when first seen in pre-dialysis clinic (eGFR ≤15ml/min/1.73m2) and when initiation of dialysis first considered (eGFR ≤10ml/min/1.73m2). Patients with co-morbidities likely to significantly reduce life expectancy were excluded (NYHA class 3 or 4 heart failure, malignancy, dementia). Comparative data on number of days spent in hospital during follow up were also collected.

Results

There were 204 patient (123 dialysis, 81 CC) with eGFR was ≤15ml/min/1.73m2. Of these, 115 went on to record an eGFR of ≤10ml/min/1.73m2 (73 dialysis, 42 CC). The median survival from eGFR first ≤15ml/min/1.73m2 for the dialysis and CC group were 42 (95% CI =33–50) and 31 (21-41) months respectively. The co-morbities adjusted HR for death in the dialysis group compared to CC was 0.61(0.41-0.61, p= 0.01). When eGFR first ≤10ml/min/1.73m2, the respective median survival times were 36 (25–47) and 12 (0-5) months. The co-morbidities adjusted HR for death in dialysis group compared to CC was 0.36 (0.21-0.62, p <0.001).
The median annualized number of hospital days (in-patient and outpatient) from eGFR ≤15mL/min/1.73m2 was 23 (IQR 10-86) for dialysis patients, and 10 (5-25) for CC. The median annualized number of hospital days (in-patient and outpatient) from eGFR ≤10mL/min/1.73m2 was 78 (IQR 18-125) for dialysis patients, and 21 (8-80) for CC.

Conclusion

This study is novel in being both prospective and in excluding patients with co-morbidly, which may limit suitability for dialysis. It indicates that dialysis increases survival in older patients, as the statistically significant difference in survival only appeared when eGFR was ≤10mL/min/1.73m2. This advantage may be offset by the increase in time spent at hospital. Hence, a future focus on quality of life is needed to establish the true benefits of dialysis in older people.