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Kidney Week

Abstract: FR-PO896

Clinical Characteristics and Outcomes of Hemodialysis Therapy Focusing on Older Patients in Korea from the 2023 Korean Renal Data System

Session Information

  • Geriatric Nephrology
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1300 Geriatric Nephrology

Authors

  • Kim, Hyunglae, The Catholic University of Korea St Vincent's Hospital, Suwon, Gyeonggi-do, Korea (the Republic of)
  • Kim, Yong Kyun, The Catholic University of Korea St Vincent's Hospital, Suwon, Gyeonggi-do, Korea (the Republic of)
  • Hong, Yu Ah, The Catholic University of Korea School of Medicine, Seoul, Korea (the Republic of)
  • Ban, Tae Hyun, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Lee, Hajeong, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Jung, Hee-Yeon, Kyungpook National University, Daegu, Korea (the Republic of)
Background

As the aging population increases worldwide, the prevalence of older patients with end-stage kidney disease (ESKD) is rapidly increasing. Understanding the characteristics of elderly ESKD patients is essential for establishing suitable dialysis policies and plans, but information on this population is currently unclear in Korea.

Methods

This study investigated the characteristics and outcomes of elderly hemodialysis patients using Korean Renal Data System. Of a total of 173,216 patients, 40,972 hemodialysis patients were included in the final analysis after excluding patients with missing values, who started dialysis before 2001, or who were younger than 18 years old.

Results

Of the enrolled patients, 39.3% were under the age of ≥ 65 years, 26.6% were 65-74 years, and 34.1% were ≥ 75 years (p<0.001). The incidence of ESKD is increasing but the prevalence is decreasing in patients aged ≥ 75 years from 2017 to 2022. The proportion of patients with cardiac disease increased with age: 16% (<65 years), 19.6% (65-74 years), and 21.8% (≥75 years) (p<0.001). The levels of body mass index, hemoglobin, albumin, calcium, phosphorus, and intact parathyroid hormone significantly decreased with increasing age (p<0.001 for each parameter). The proportions of arteriovenous fistula creation and left forearm placement reduced with increasing age (p<0.001, and p<0.001, respectively). Although low surface area (1.0-1.5 m2) dialyzers utilization was increased with age at 41.4% (<65 years), 49.5% (65-74 years), and 58.5% (≥75 years), the urea reduction ratio and Kt/V increased with age, achieving the dialysis adequacy target in all elderly population. Mortality rates had increased in patients aged ≥ 75 years compared to other age groups over the past 20 years and the proportion of deaths due to cardiovascular disease decreased and deaths due to infectious diseases increased with age in older hemodialysis patients (p=0.002, and p=0.025, respectively).

Conclusion

The incidence of elderly hemodialysis patients has increased over time, and especially very older adults aged ≥ 75 years has a higher risk of mortality compared to other age groups in Korea. To improve outcomes for older ESKD patients, appropriate guidelines for ESKD management should be developed based on age-appropriate, individualized strategies.