Abstract
Objectives
Advanced age is associated with shorter survival on dialysis. The aim of the present study was to compare the adherence with KDOQI guideline targets and the association between mortality and satisfying the guidelines targets between hemodialysis patients aged 65 years and over and those younger than 65 years.
Methods
Data were collected using a questionnaire sent to all 46 HD centers in Serbia with totally 3868 HD patients. The 24 centers responded and sent the data on all patients aged 18 years or older that were on regular HD for more than 3 months (2153 patients, 1320 males, aged 18–90 years). Data are presented in two groups: a group of patients younger than 65 years (1438, 66.8 %) and a group of patients aged 65 years and over (715, 33.2 %). The percentage of patients whose values failed to meet the targets recommended by KDOQI Clinical Practice Guidelines was calculated for dialysis dose (spKt/V), hemoglobin, serum phosphorus, serum calcium and plasma iPTH (150–300 pg/mL). Patients were followed from enrollment until their death, kidney transplantation, departure from the center or the end of the study.
Results
Elderly patients were more likely to have hypertension, significantly lower systolic and diastolic blood pressure and smaller dialysis vintage than younger patients. They were less frequently treated with high-flux membranes and hemodiafiltration and they had significantly lower number of dialysis hours per week and significantly lower interdialytic weight gain. They used ESA and phosphate binders less frequently than younger patients (p < 0.001 and p = 0.002). Older patients had similar Kt/V as younger ones but they had significantly more frequent Hb level outside the target range than younger patients. During the year follow-up period, by using a Cox proportional hazards model it has been confirmed that age, dialysis vintage, weekly dialysis time and target values for Kt/V were significant independent predictors of time to death for younger patients and gender, dialysis vintage and iPTH were independent predictor of time to death for older patients.
Conclusion
Despite less favorable dialysis prescription, older patients had similar Kt/V and less frequent deviations from the target values proposed by KDOQI for serum phosphorus and iPTH but more frequent deviation for Hb value as compared with younger patients. Risk factors for mortality differ between older and younger patients; out of five KDOQI targets, only Kt/V proved to be a significant risk factor for mortality for younger and iPTH for older patients.
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References
Collins AJ, Kasiske B, Herzog C et al (2007) Excerpts from the United States renal data system 2006 annual data report. Am J Kidney Dis 49(1 Suppl 1):A6–A7
Kurella M, Covinsky KE, Collins AJ et al (2007) Octogenarians and nonagenarians starting dialysis in the United States. Ann Intern Med 146:177–183
Murtagh FE, Marsh JE, Donohoe P et al (2007) Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5. Nephrol Dial Transplant 22:1955–1962
Carson RC, Juszczak M, Davenport A et al (2009) Is maximum conservative management an equivalent treatment option to dialysis for elderly patients with significant comorbid disease? Clin J Am Soc Nephrol 4:1611–1619
Chang TI, Paik J, Greene T et al (2010) Updated comorbidity assessments and outcomes in prevalent hemodialysis patients. Hemodial Int 14:478–485
Miskulin DC, Martin AA, Brown R et al (2004) Predicting 1 year mortality in an outpatient haemodialysis population: a comparison of comorbidity instruments. Nephrol Dial Transplant 19:413–420
Lopez Revuelta K, Garcia Lopez FJ, de Alvaro Moreno F et al (2004) Perceived mental health at the start of dialysis as a predictor of morbidity and mortality in patients with end-stage renal disease (CALVIDIA Study). Nephrol Dial Transplant 19:2347–2353
Jhamb M, Argyropoulos C, Steel JL et al (2009) Correlates and outcomes of fatigue among incident dialysis patients. Clin J Am Soc Nephrol 4:1779–1786
Thong MS, Kaptein AA, Benyamini Y et al (2008) Association between a self-rated health question and mortality in young and old dialysis patients: a cohort study. Am J Kidney Dis 52:111–117
Issad B, Benevent D, Allonache M, Durand PY, Aguilera D, Milongo R et al (1996) 213 Elderly uremic patients over 75 years of age treated with long-term peritoneal dialysis: a French multicenter study. Perit Dial Int 16(Suppl I):S414–S418
Joly D, Anglicheau D, Alberti C, Nguyen AT, Touam M, Grunfeld JP, Jungers P (2003) Octogenarians reaching end-stage renal disease: cohort study of decision-making and clinical outcomes. J Am Soc Nephrol 14:1012–1021
Port FK, Pisoni RL, Bommer J, Locatelli F, Jadoul M, Eknoyan G et al (2006) Improving outcomes for dialysis patients in the international Dialysis Outcomes and Practice Patterns Study. Clin J Am Soc Nephrol 1(2):246–255
Moret KE, Grootendorst DC, Dekker FW, Boeschoten EW, Krediet RT, Houterman S, NECOSAD Study Group et al (2012) Agreement between different parameters of dialysis dose in achieving treatment targets: results from the NECOSAD study. Nephrol Dial Transplant 27(3):1145–1152
Lebner AC, Beard KM, Soroka SD, Cournoyer SH, Da Roza GA, Geary DF et al (2011) Interprovincial differences in the achievement of K/DOQI targets of mineral metabolism in Canada. Nephrol Dial Transplant 26(1):156–163
Piera L, Cruz JM, Braga-Gresham JL, Eichleay MA, Pisoni RL, Port FK (2007) Estimación, según el estudio DOPPS, de los años de vida de pacientes atribuibles a las prácticas de hemodiálisis modificables en España. Nefrologia 27(4):496–504
Djukanović L, Aksić-Miličević B, Antić M, Baković J, Varga Ž, Gojaković B et al (2012) Epidemiology of end-stage renal disease and hemodialysis treatment in Serbia at the turn of the millennium. Hemodial Int 16(4):517–525
NKF-KDOQI Guidelines. http://www.kidney.org/professionals/KDOQI/guideline_upHD_PD_VA/index.htm Accessed 16 Nov 2014
Daugirdas JT (1993) Second generation logarithmic estimates of single-pool variable volume Kt/V: an analysis of error. J Am Soc Nephrol 4:1205–1213
Djukanovic N, Djuric Z, Knezevic V, Lazarevic T, Ljubenovic S, Markovic R, Rabrenovic V, Marinkovic J, Dimkovic N (2014) Hemodialysis practice in Serbia and guidelines implementation. 51th ERA-EDTA Congress, May 31–June 3, Amsterdam, MP389
Dimkovic N, Marinkovic J, Djuric Z, Knezevic V, Lazarevic T, Ljubenovic S, Markovic R, Rabrenovic V, Djukanovic L (2014) Predictors of mortality for patients on regular hemodialysis in Serbia. 51th ERA-EDTA Congress, May 31–June 3, Amsterdam, MP514
Adas H, Al-Ramahi R, Jaradat N, Badran R (2014) Assessment of adequacy of hemodialysis dose at a Palestinian hospital. Saudi J Kidney Dis Transplant 25(2):38–42
Suleymanlar G, Utas C, Ecder T, Ates K, Bieber B, Robinson BM et al (2014) The Dialysis Outcomes and Practice Patterns Study (DOPPS) in Turkey: study design and initial comparisons with Turkish registry data. Nephrol Dial Transplant 29(suppl 3):iii516–iii527 MP561
Canaud B, Tentori F, Akiba T, Karaboyas A, Gillespie B, Akizawa T et al (2011) Clinical practices and outcome in elderly hemodialysis patients: results from the dialysis outcomes and practice patterns study (DOPPS). Clin J Am Soc Nephrol 6(7):1651–1662
Chandna SM, Da Silva-Gane M, Marshall C, Warwicker P, Greenwood RN, Farrington K (2011) Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy. Nephrol Dial Transplant 26(5):1608–1614. doi:10.1093/ndt/gfq630
Al Saran K, Sabry A, Hassan AH, Al Halawany Z (2011) Evaluation of quality of care in a large Saudi Hemodialysis Center (Prince Salman Center for Kidney Diseases, Riyadh, KSA). Ren Fail 33(6):555–561
Yavuz A, Ersoy F, Passadakis PS, Tam P, Evaggelos DM, Katopodis KP (2008) Phosphorus control in peritoneal dialysis patients 73:S152–S158
Dialysis Outcomes and Practice Patterns Study. 2009 DOPPS annual report. http://www.dopps.org/annualreport/index.htm. Accessed 13 June 2014
Block G, Port FK (2003) Calcium phosphate metabolism and cardiovascular disease in patients with chronic kidney disease. Semin Dial 16:140–147
Blumberg J (1997) Nutritional needs of seniors. J Am Coll Nutr 16:517–523
Ibrahim S (2010) Quality of care assessment and adherence to the international guidelines considering dialysis, water treatment, and protection against transmission of infections in university hospital-based dialysis units in Cairo, Egypt. Hemodial Int 14(1):61–67. doi:10.1111/j.1542-4758.2009.00398.x
Lamb EJ, Hodsman A, van Schalkwyk D, Ansell D, Warwick G (2007) Serum calcium, phosphate, parathyroid hormone, albumin, aluminum and cholesterol achievement on replacement therapy (chapter 9). Nephrol Dial Transplant 22(Suppl 7):vii105–vii118
Dimkovic NB, Bargman J, Vas S, Oreopoulos DG (2002) Normal or low initial PTH levels are not a predictor of morbidity/mortality in patients undergoing chronic peritoneal dialysis. Perit Dial Int 22(2):204–210
Stevens LA, Djurdjev O, Cardew S, Cameron EC, Levin A (2004) Calcium, phosphate, and parathyroid hormone levels in combination and as a function of dialysis duration predict mortality: evidence for the complexity of the association between mineral metabolism and outcomes. J Am Soc Nephrol 15:770–779
Young EW, Albert JM, Satayathum S, Goodkin DA, Pisoni RL, Akiba T et al (2005) Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Patterns Study. Kidney Int 67:1179–1187
Covic A, Kothawala P, Bernal M, Robbins S, Chalian A, Goldsmith D (2009) Systematic review of the evidence underlying the association between mineral metabolism disturbances and risk of all-cause mortality, cardiovascular mortality and cardiovascular events in chronic kidney disease. Nephrol Dial Transplant 24:1506–1523
Palmer SC, Hayen A, Macaskill P, Pellegrini F, Craig JC, Elder GJ et al (2011) Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis. JAMA 305:1119–1127
Natoli JL, Boer R, Nathanson BH, Miller RM, Chiroli S, Goodman WG et al (2013) Is there an association between elevated or low serum levels of phosphorus, parathyroid hormone, and calcium and mortality in patients with end stage renal disease?. A meta-analysis. BMC Nephrol 14:88. doi:10.1186/1471-2369-14-88
Fukagawa M, Kido R, Komaba H, Onishi Y, Yamaguchi T, Hasegawa T et al (2014) Abnormal mineral metabolism and mortality in hemodialysis patients with secondary hyperparathyroidism: evidence from marginal structural models used to adjust for time-dependent confounding. Am J Kidney Dis 63(6):979–987
Rath T, Mactier RA, Weinreich T, Scherhag AW, on behalf of the GAIN investigators (2009) Effectiveness and safety of recombinant human erythropoietin beta in maintaining common hemoglobin targets in routine clinical practice in Europe: the GAIN study. Curr Med Res Opin 25:961–970
Van der Weerd NC, Grooteman MP, Blankestijn PJ, Mazairac AH, van den Dorpel MA, den Hoedt CH CH, CONTRAST Investigators et al (2012) Poor compliance with guidelines on anemia treatment in a cohort of chronic hemodialysis patients. Blood Purif 34(1):19–27
Wiecek A, Covic A, Locatelli F, MacDougall IC, ORAMA Study Group (2008) Renal anemia: comparing current Eastern and Western European management practice (ORAMA). Ren Fail 30(3):267–276
McFarlane PA, Pisoni RL, Eichleay MA, Wald R, Port FK, Mendelssohn D (2010) International trends in erythropoietin use and hemoglobin levels in hemodialysis patients. Kidney Int 78(2):215–223
Locatelli F, Pisoni RL, Combe C, Bommer J, Andreucci VE, Piera L et al (2004) Anemia in haemodialysis patients of five European countries: association with morbidity and mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 19:121–132
Hanafusa N, Nomura T, Hasegawa T, Nangaku M (2014) Age and anemia management: relationship of hemoglobin levels with mortality might differ between elderly and nonelderly hemodialysis patients. Nephrol Dial Transplant 29(12):2316–2326. doi:10.1093/ndt/gfu272
Acknowledgments
The authors thank all the colleagues from Serbian hemodialysis centers contributing on the study (in alphabetical order): Branislav Andrić (Kruševac), Jasmina Bogdanović (Valjevo), Ivana Budošan (Novi Sad), Anica Cvetičanin (Sremska Mitrovica), Kosta Djordjev (Vršac), Verica Djordjević (Smederevska Palanka), Branimir Haviža Lilić (Pirot), Nasta Jovanović (Žagubica), Rosa Jelačić (Zrenjanin), Svetislav Kostić (Niš), Ivko Marić(Lazarevac), Srboljub Milenković (Kosovska Mitrovica), Olivera Milićević (Kikinda), Igor Mitić (Novi Sad), Vesna Mićunović (Vrbas), Milena Mišković (Obrenovac), Dragana Pilipović (Bačka Palanka), Steva Plješa (Zemun), Miroslava Radaković (Barajevo), Marina Stojanović Stanojević (Mladenovac), Biserka Tirmenštajn Janković (Zaječar), Goran Vojinović (Pančevo), Kornelija Šefer (Subotica).
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Dimković, N., Djukanović, L., Marinković, J. et al. Achievement of guideline targets in elderly patients on hemodialysis: a multicenter study. Int Urol Nephrol 47, 1555–1563 (2015). https://doi.org/10.1007/s11255-015-1055-4
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DOI: https://doi.org/10.1007/s11255-015-1055-4