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Geriatric Nephrology and Urology

, Volume 7, Issue 1, pp 1–10 | Cite as

Ten years experience of renal replacement treatment in the elderly

  • Fabio Malberti
  • Ferruccio Conte
  • Aurelio Limido
  • Daniele Marcelli
  • Donatella Spotti
  • Fulvio Lonati
  • Francesco Locatelli
Article

Abstract

Elderly patients constitute an increasing segment of the end-stage renal disease population beginning renal replacement therapy (RRT) in the Western Countries. In this study we studied 2447 end-stage renal disease (ESRD) patients who started renal replacement treatment (RRT) in Lombardy between 1983 and 1992 at the age of 65 or older, with particular emphasis on survival and morbidity.

In the last decade the number of elderly patients admitted yearly to RRT increased from 113 [102 per milion population (pmp), 20% of all accepted patients] in 1983 to 375 (282 pmp, 42% of all accepted patients) in 1992. The most frequent primary nephropathies in 1992 were glomerulonephritis (21% vs 25% in 1983), vascular diseases (18% vs 13%) and diabetes (12% vs 7%). The use of acetate HD and IPD declined over the 10 years period from 49 to 11% and from 26 to 5%; that of bicarbonate HD and CAPD increased from 3 to 46% and from 26 to 32%. Hospitalization rate was related to age, sex, presence of systemic nephropathies or malignancy, but not to treatment modality. The main causes of death in 1992 were cardiovascular diseases (53 vs 42% in 1983) and cachexia (24 vs 18%). The survival rate of all elderly patients was 64, 39 and 13% at 2, 4 and 8 years. The covariates affecting patient survival (Cox model) were the presence at the start of RRT of systemic nephropathies (Hazard ratio 1.7), systemic atherosclerosis (1.6), other comorbidity conditions (1.38) and peritoneal dialysis (1.31).

Conclusions: (1) The progressive increase in the number of patients admitted to RRT in the last decade is due to loose criteria of acceptance of elderly patients (increase in the acceptance rate of diabetics and patients with vascular disease), (2) patients' survival is affected by the presence of comorbid conditions at the start of RRT, (3) the worse survival rate in peritoneal dialysis could result from a hidden negative selection of patients, unmeasured by Cox analysis.

elderly ESRD patients dialyis survival morbidity 

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References

  1. 1.
    Eggers PW. Mortality rate among dialysis patients in Medicare's end-stage renal disease program. Am J Kidney Dis 1990; 15: 414-21.Google Scholar
  2. 2.
    Posen GA, Jeffrey JR, Fenton SSA, Arbus GS. Results from the Canadian renal failure registry. Am J Kidney Dis 1990; 15: 397-401.Google Scholar
  3. 3.
    Ismail N, Hakim RM, Oreopoulos DG, Patrikarea A. Renal replacement therapies in the elderly: Part 1. Hemodialysis and Chronic Peritoneal Dialysis. Am J Kidney Dis 1993; 22: 759-82.Google Scholar
  4. 4.
    Brunner FP, Selwood NH. Results of renal replacement therapy in Europe, 1980 to 1987. Am J Kidney Dis 1990; 15: 384-96.Google Scholar
  5. 5.
    Brunner FP, Selwood NH. Profile of patients on RRT in Europe and death rates due to major causes of death groups. Kidney Int 1992; 42: S4-S15.Google Scholar
  6. 6.
    Collins AS, Hanson G, Human A, Kjellstrand C, Keshaviah P. Changing risk factor demographics in end-stage renal disease patients entering hemodialysis and the impact on long-term mortality. Am J Kidney Dis 1990; 15: 422-32.Google Scholar
  7. 7.
    Locatelli F, Marcelli D, Conte F, Limido A, Lonati F, Malberti F, Spotti D. 1983 to 1992: Report on regular dialysis and transplantation in Lombardy. Am J Kidney Dis 1995; 25: 196-205.Google Scholar
  8. 8.
    Cox DR. Regression models and life tables (with discussion). J R Statist Soc 1972; 34: 197-220.Google Scholar
  9. 9.
    Port FK. The end-stage renal disease program: trends over the past 18 years. Am J Kidney Dis 1992; 20: 3-7.Google Scholar
  10. 10.
    US Renal Data System. 1991 annual data report. Am J Kidney Dis 1991; 18: S38-S48.Google Scholar
  11. 11.
    11. The USRDS 1994 Annual Data Report. Patient survival. Am J Kidney Dis 1994; 24: S76-S87.Google Scholar
  12. 12.
    12. Valderrabano F, Jones EHP, Mallick NP. Report on management of renal failure in Europe, XXIV, 1993. Nephrol Dial Transplant 1995; 10(Suppl. 5): 1-25.Google Scholar
  13. 13.
    Segoloni GP, Salomone M, Piccoli GB. CAPD in the elderly: Italian Multicenter Study experience. Adv Perit Dial 1990; 6: 56-60.Google Scholar
  14. 14.
    Keane WK, Collins AJ. Incidence of Co-morbidity on mortality and morbility in patients treated with hemodialysis. Am J Kidney Dis 1994; 24: 1010-8.Google Scholar
  15. 15.
    Foley RN, Parfrey PS, Harnett JD, Kent GM, Martin CJ, Murray DC, Barre PE. Clinical and echocardiographic disease in patients starting end-stage renal disease therapy Kidney Int 1995; 47: 186-92.Google Scholar
  16. 16.
    Harnett JD, Foley RN, Kent GM, Parfrey PS, Martin CJ, Murray DC, Barre PE. Congestive heart failure in dialysis patients: prevalence, incidence, prognosis and risk factors. Kidney Int 1995; 47: 884-90.Google Scholar
  17. 17.
    Charra B, Calemard E, Ruffet M, Chazot C, Terrat JC, Vanel T, Laurent G. Survival as an index of adequacy of dialysis. Kidney Int 1992; 41: 1286-91.Google Scholar
  18. 18.
    Tomita J, Kimura TJ, Inoue T, Inenaga T, Sanai T, Kawano Y, Nakamura S, Baba S, Matsouoka H, Omae T. Role of systolic blood pressure in determining prognosis of hemodialyzed patients. Am J Kidney Dis 1995; 25: 405-12.Google Scholar
  19. 19.
    Burton PR, Walls J. Selection-adjusted comparison of life expectancy of patients on continuous ambulatory peritoneal dialysis, hemodialysis and renal transplantation. Lancet 1987; i: 1115-9.Google Scholar
  20. 20.
    Nolph KD. Comparison of continuous ambulatory peritoneal dialysis and hemodialysis. Kidney Int 1988; 33 (Suppl. 24): 123-31.Google Scholar
  21. 21.
    Gentil MA, Carriazzo A, Pavon MI, Rosato M, Castillo D, Ramos B, Algarra GR, Tejuca F, Banasco VP, Milan JA. Comparison of survival in continuous ambulatory peritoneal dialysis and hospital haemodialysis: a multicentric study. Nephrol Dial Transplant 1991; 6: 444-51.Google Scholar
  22. 22.
    Gokal R, Baillod R, Bogle S, Hunt L, Jakubowski C, Marsh F, Ogg C, Oliver D, Ward M, Wilkinson R. Multicenter study on outcome of treatment in patients on continuous ambulatory peritoneal dialysis and haemodialysis. Nephrol Dial Transplant 1987; 2: 12-8.Google Scholar
  23. 23.
    Maiorca R, Vonesh EF, Cancarini GC, Cantaluppi A, Manili L, Brunori G, Camerini C, Feller P, Strada A. A six-year comparison of patient and technique survivals in CAPD and HD. Kidney Int 1988; 34: 518-24.Google Scholar
  24. 24.
    Maiorca R, Vonesh EF, Cavalli PL, De Vecchi A, Giangrande A, La Greca G, Scarpioni LL, Bragantini L, Cancarini GC, Cantaluppi A, Castelnuovo C, Castiglioni A, Poisetti PG, Viglino PG. A multicenter, selection adjusted comparison of patients and technique survivals on CAPD and hemodialysis. Peritoneal Dialysis Int 1991; 11: 118-27.Google Scholar
  25. 25.
    Nicolucci A, Cubasso D, Labbrozzi D, Mari E, Impicciatore P, Procaccini DA, Forcella M, Stella I, Querques M, Pappani A, Passione A, Strippoli P. Effect of coexistant diseases on survival of patients undergoing dialysis. ASAIO Journal 1992; 38: 291-5.Google Scholar
  26. 26.
    Lupo A, Cancarini G, Catizzone L, Cocchi R, De Vecchi A, Viglino G, Salomone M, Segoloni G, Giangrande A, Limido A, Conte F, Lonati F, Piccoli G, Quarello F. Comparison of survival in CAPD and hemodialysis: a multicenter study. Advances in Peritoneal Dialysis. 1992; 136-40.Google Scholar
  27. 27.
    Nelson CB, Port FK, Guize KE. Dialysis patient survival: evaluation of CAPD vs HD techniques. Perit Dial Int 1992; 12(Suppl. 1): 144.Google Scholar
  28. 28.
    Held PJ, Port FK, Hamburger RJ, Gaylin DS, Turenne MN, Wolfe RA. Continuous ambulatory peritoneal dialysis and hemodialysis: comparison of patients mortality with adjustment for comorbid conditions. Kidney Int 1994; 45: 1163-9.Google Scholar
  29. 29.
    29. Marcelli D, Stannard D, Conte F, Held PJ, Locatelli F, Port FK. ESRD patient mortality with adjustment for comorbid conditions in Lombardy (Italy) versus the United States. Kidney Int 1996; 50: 1013-8.Google Scholar
  30. 30.
    US Renal Data System. 1992 Annual Data Report. Comorbid conditions and correlation with mortality risk among 3399 incident HD patients. Am J Kidney Dis 1992; 20: S32-S38.Google Scholar
  31. 31.
    Collins AJ, Ma JZ, Umen A, Keshaviah P. Urea index and other predictors of hemodialysis patient survival. Am J Kidney Dis 1994; 23: 272-82.Google Scholar
  32. 32.
    Lowrie L, Lew N. Death risk in hemodialysis patients. The predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 1990; 15: 458-92.Google Scholar

Copyright information

© Kluwer Academic Publishers 1997

Authors and Affiliations

  • Fabio Malberti
  • Ferruccio Conte
  • Aurelio Limido
  • Daniele Marcelli
  • Donatella Spotti
  • Fulvio Lonati
  • Francesco Locatelli

There are no affiliations available

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