NDT Advance Access published online on April 4, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfm153
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Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5
1Department of Palliative Care and Policy, King's College Hospital, London, 2Department of Renal Medicine, Epsom and St Helier University Hospitals, Surrey, 3Department of Renal Medicine, King's College Hospital London, 4Division of Renal Medicine, St George's Hospital, London and 5Department of Renal Medicine, Guy's and St Thomas’ Hospital, London, UK
Correspondence and offprint requests to: Dr Fliss Murtagh, Department of Palliative Care and Policy, King's College London, Weston Education Centre, Cutcombe Rd, London, Se5 9RJ, UK. Email: fliss.murtagh{at}kcl.ac.uk
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Abstract |
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Background. The number of elderly patients with chronic kidney disease (CKD) stage 5 is steadily increasing. Evidence is needed to inform decision-making for or against dialysis, especially in those patients with multiple comorbid conditions for whom dialysis may not increase survival. We therefore compared survival of elderly patients with CKD stage 5, managed either with dialysis or conservatively (without dialysis), after the management decision had been made, and explored which of several key variables were independently associated with survival.
Methods. A retrospective analysis of the survival of all over 75 years with CKD stage 5 attending dedicated multidisciplinary pre-dialysis care clinics (n = 129) was performed. Demographic and comorbidity data were collected on all patients. Survival was defined as the time from estimated GFR <15 ml/min to either death or study endpoint.
Results. One- and two-year survival rates were 84% and 76% in the dialysis group (n = 52) and 68% and 47% in the conservative group (n = 77), respectively, with significantly different cumulative survival (log rank 13.6, P < 0.001). However, this survival advantage was lost in those patients with high comorbidity scores, especially when the comorbidity included ischaemic heart disease.
Conclusions. In CKD stage 5 patients over 75 years, who receive specialist nephrological care early, and who follow a planned management pathway, the survival advantage of dialysis is substantially reduced by comorbidity and ischaemic heart disease in particular. Comorbidity should be a major consideration when advising elderly patients for or against dialysis.
Keywords: chronic kidney disease stage 5; comorbidity; conservative management; elderly; survival
Dr Neil S. Sheerin and Dr Fiona E. Harris contributed equally to this work.
Received for publication: 24. 7.06
Accepted in revised form: 28. 2.07
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