Survival of patients ≥70 years with advanced chronic kidney disease: Dialysis vs. conservative care

Abstract

Introduction: The number of elderly patients with advanced chronic kidney disease (ACKD) has increased in recent years, and the best therapeutic approach has not been determined due to a lack of evidence. Objectives: To observe the progression of elderly patients with ACKD (stages 4 and 5) and to compare the survival of stage 5 CKD patients with and without dialysis treatment. Material and methods: All patients ≥70 years who began ACKD follow-up from 01/01/2007 to 31/12/2008 were included, and their progression was observed until 31/12/2013. Demographic data, the Charlson comorbidity index, history of ischaemic heart disease (IHD) and diabetes mellitus (DM) were assessed. Results: A total of 314 patients ≥70 years with stages 4 and 5 CKD were studied. Of these patients, 162 patients had stage 5 CKD at the beginning of follow-up or progressed to stage 5 during the study, and 69 of these patients were treated with dialysis. In the stage 5 group, median age was 77 years (74–81); 48% had IHD; 50% had DM, Charlson 7 (6–9). Kaplan–Meier survival analysis: ≥70 years (93 vs. 69 patients with dialysis, log rank: 15 p < 0.001); patients ≥75 years (74 vs. 46 patients with dialysis, log rank: 8.9 p = 0.003); patients ≥80 (40 vs. 15 patients with dialysis) and p = 0.2. Patients receiving dialysis were younger, with a lower Charlson comorbidity index and shorter follow-up time. Conclusions: Our study shows that dialysis treatment improves survival, although this benefit is lost in patients ≥80 years.

Keywords

• Advanced chronic kidney disease
• Elderly
• Survival
• Conservative care
• Frail patient