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Kidney Week

Abstract: SA-PO734

Hospitalizations within the First Year and Survival in Patients Aged Above 80 Who Start Dialysis in Emergency

Session Information

  • Geriatric Nephrology
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Saudan, Patrick, Geneva University Hospitals, Geneva, Switzerland
  • Alves, Cyrielle, Geneva University Hospitals, Geneva, Switzerland
  • Frandsen, Amalie, SZO Visp, Zeneggen, Switzerland
  • Ernandez, Thomas, Geneva University Hospitals, Geneva, Switzerland
  • Martin, Pierre-Yves F., Geneva University Hospitals, Geneva, Switzerland
Background

Implementation of dialysis in octogenarians is a debated question on account of an unfavourable short-term prognosis. We therefore analyzed what is the impact of planned implementation versus emergency dialysis on first year hospitalizations and survival in this population.

Methods

During the past 16 years, all patients who started maintenance dialysis in our unit were reviewed. Patient’s demographic and clinical characteristics were collected. Emergency implementation of maintenance dialysis was defined as no prior referral to a nephrologist one month before starting dialysis.

Results

From 2000 to the end of 2016, 684 patients started maintenance dialysis in our unit, of whom 96 were aged 80 and above. Mean age was 83 + 2.4 years. Hemodialysis and peritoneal dialysis were implemented in 78 and 18 patients respectively. There were 66% male, 33 % diabetic and median eGFR at start of dialysis was 8+ 3 ml/min. Emergency dialysis was implemented in 44% of the patients. Overall mean survival was 33 + 3 months. One-year mortality was 36.4% in referred patients who had emergency dialysis and 11.5% patients with planned dialysis. One-year mean survival was 334+12 days in patients with planned dialysis implementation versus 274+ 21days in those who had emergency dialysis (p< 0.004). In a multivariate analysis including prior referral, age, gender, comorbidity score and dialysis modality, one-year survival was only associated with prior referral (HR: 0.36; 95% CI. 013-0.98). In patients with planned dialysis implementation, one -year hospitalization-free days were 269+108 versus 212+ 136 days in those who had emergency dialysis (p< 0.03).

Conclusion

Prior referral to nephrologists substantially increase one-year hospitalization-free days and survival after dialysis implementation in ESKD patients aged above 80.