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Abstract: TH-PO787

Rates and Predictors of Mortality in Different Age Groups of Elderly With Maintenance Hemodialysis: A Large Observational Cohort Study in 17,354 Patients

Session Information

Category: Geriatric Nephrology

  • 1200 Geriatric Nephrology

Authors

  • Noppakun, Kajohnsak, Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  • Ruengorn, Chidchanok, Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
  • Tantraworasin, Apichat, Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
  • Khorana, Jiraporn, Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Background

Maintenance hemodialysis (MHD) is a life-saving procedure for end-stage kidney disease (ESKD) patients. Although there is no age limit for an initiation of MHD, survival benefits of HD in very elderly patients are questionable. We aimed to identify the groups of elderly patients who have high mortality rates after an initiation of MHD.

Methods

Elderly (≥70 years) patients initiated MHD between Jan 2005 and Dec 2020 were recruited. All data were retrieved from Thailand Renal Replacement Therapy Registry data. Patients were divided into 3 groups according the age at dialysis initiation: 70 to <85 (n=15955), 85 to <90 (n=1151), and ≥90 years (n=248).

Results

17,354 patients were recruited, 46.46% were male with mean age of 76.9±5.1 years. The total mortality rate was 36.35% with the median (IQR) follow-up time of 40.45 (0.03-192.1) months and the total time-at-risk of 76,624 years. Comparing with the group aged 70 to <85 years, the group aged 85 to <90 and ≥90 years had increased risk of death with hazard ratio (HR) 1.93 (95%CI 1.76-2.13;p<0.001) and 3.06 (95%CI 2.51-3.74;p<0.001), respectively. About 82.2% (95%CI 81.6-82.8) of the patients aged between 70 and <85 years died during 7-8 years after dialysis initiation, while 81.4% (95%CI 79.3-83.4) of patients ≥85 years of age died during 4-5 years after dialysis initiation. From multivariable analyses, predictors for mortality in the group ≥85 years of age were Karnofsky Performance Status Scale (KPSS) ≤50 (vs ≥60) with HR 4.56 (95%CI 1.57-13.29;p=0.005), eGFR at dialysis initiation ≥7 mL/min/1.73m2 (vs <7) with HR 2.26 (95%CI 1.11-4.60;p=0.024), and serum albumin <3.5 g/dL (vs ≥3.5) with HR 2.22 (95%CI 1.19-4.15;p=0.012). The HR for death in patients ≥85 years of age with combination of the three potential predictors; KPSS ≤50 and eGFR ≥7 mL/min/1.73m2 and serum albumin at dialysis initiation <3.5 g/dL, was 5.02 (95%CI 2.12-11.88;p<0.001) compared to patients in the same age group without those characteristics.

Conclusion

In elderly with ESKD, MHD is justified in patients aged between 70 and 85 years as most of them had reasonable survival rates. However, in patients who were older than 85 years, mortality rate was high in those with KPSS ≤50, eGFR ≥7 mL/min/1.73m2 and serum albumin at dialysis initiation <3.5 g/dL.