NDT Advance Access published online on July 5, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfm400
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Associations between comorbidities, treatment choice and outcome in the elderly with end-stage renal disease
1REIN Registry, Agence de la biomédecine, La Plaine Saint Denis, France, 2Inserm Unit 780, Villejuif, France, 3University Paris-Sud, Faculty of Medicine, IFR69, Villejuif, France, 4Nephrology Unit, Nancy University Hospital, Vandoeuvre-lès-Nancy, France, 5Nephrology Unit, Lyon-Sud University Hospital, Pierre-Bénite, France and 6Nephrology Unit, Limoges University Hospital, Limoges, France
Correspondence and offprint requests to: Cécile Couchoud, Coordination Nationale du Projet REIN, Agence de la Biomédecine, 1 avenue du Stade de France, 93212 Saint Denis La Plaine Cedex, France. Email: cecile.couchoud{at}biomedecine.fr
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Abstract |
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Background. New patients treated for end-stage renal disease are increasingly elderly: in France, 38% are 75 years or older. The best treatment choices for the elderly are still debated.
Methods. We studied case-mix factors associated with choice of initial dialysis modality and 2-year survival in the 3512 patients aged 75 years or older who started dialysis between 2002 and 2005 and were included in the French REIN registry.
Results. Overall, 18% began with peritoneal dialysis (PD), 50% with planned haemodialysis (planned HD) and 32% with unplanned HD, that is, HD that started on an emergency basis. At least one comorbid condition was reported for 85%, and three or more for 36%, but case-mix varied with age. PD was chosen significantly more often than planned HD for the oldest (
85) compared with the youngest (75–79) patients: odds ratio 2.1 (95% confidence interval, 1.5–2.8), in those with congestive heart failure: 1.8 (1.5–2.3) and severe behavioural disorder: 2.2 (1.3–3.5), but less often for obese patients: 0.5 (0.3–0.8) and smokers: 0.4 (0.2–0.9). Two-year survival rates were 58, 52 and 39% in patients aged 75–79, 80–84 and 85, respectively. Compared with planned HD, unplanned HD was associated with a risk of mortality 50% higher, and PD with a risk 30% higher, independent of patient case-mix.
Conclusion. PD is a common treatment option in French elderly patients, but our study suggests the need for caution in the long-term use. The high frequency of unplanned HD would require further attention.
Keywords: comorbidity; elderly; end-stage renal disease; epidemiology; outcome; peritoneal dialysis
Received for publication: 2. 4.07
Accepted in revised form: 29. 5.07
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