Suboptimal initiation predicts short-term prognosis and vulnerability among very elderly patients who start haemodialysis.

Publisher: Blackwell Science Country of Publication: Australia NLM ID: 9615568 Publication Model: Print Cited Medium: Internet ISSN: 1440-1797 (Electronic) Linking ISSN: 13205358 NLM ISO Abbreviation: Nephrology (Carlton) Subsets: MEDLINE

Original Publication: Carlton, Vic., Australia : Blackwell Science,

Vulnerable Populations*; Catheterization, Central Venous/*mortality ; Kidney Failure, Chronic/*mortality ; Kidney Failure, Chronic/*therapy ; Renal Dialysis/*mortality; Age Factors ; Aged, 80 and over ; Aging ; Catheterization, Central Venous/adverse effects ; Catheterization, Central Venous/instrumentation ; Catheters, Indwelling ; Cause of Death ; Central Venous Catheters ; Clinical Decision-Making ; Comorbidity ; Female ; Frail Elderly ; Frailty/diagnosis ; Frailty/mortality ; Geriatric Assessment ; Humans ; Japan ; Kidney Failure, Chronic/diagnosis ; Kidney Failure, Chronic/physiopathology ; Male ; Renal Dialysis/adverse effects ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome

Aim: A recent, growing concern regarding haemodialysis in Japan is a sustained increase in the elderly population. Among very elderly people who start haemodialysis, the prognosis is considered to be poor; however, this has not been fully elucidated. This study aimed to discover the short-term prognosis and related factors in very elderly patients who commence haemodialysis.
Methods: Between January 2008 and December 2013, 122 patients aged ≥85 years at haemodialysis initiation were documented in our hospital. Predictors of 90-day and 1-year mortality after haemodialysis initiation were assessed with Cox proportional hazards regression analysis. Selection of covariates for the multivariate model was based on forward stepwise selection using the probability of a likelihood ratio statistics.
Results: The subjects' mean age was 87.4 ± 2.5 years, and 48% were female. The most common cause of death was infection (38% of patients) and the leading cause of infectious death was pneumonia. The 90-day and 1-year survival rates were 81% and 62%, respectively. Suboptimal initiation was a significant prognostic factor for 90-day [hazard ratio (HR) 3.98, 95% confidence interval (CI) 1.18-13.43] and 1-year [HR 3.19, 95% CI 1.51-6.76] mortality after adjusting for confounders in multivariate analysis.
Conclusion: Very elderly patients who started haemodialysis had a poor prognosis, and suboptimal initiation significantly predicted outcome. Shared decision-making with patients and their families is needed for initiating haemodialysis on the conditions that appropriate information on the expected prognosis is provided.
(© 2017 Asian Pacific Society of Nephrology.)

Keywords: elderly; frailty; haemodialysis; initiation; prognosis

Date Created: 20171114 Date Completed: 20190409 Latest Revision: 20220408

20221213

10.1111/nep.13194

29131496