Clinical Outcome in Elderly Patients on Chronic Peritoneal Dialysis: A Retrospective Study from a Single Center in China

Abstract

We aimed to evaluate clinical outcomes and identify the predictors of mortality in elderly patients undergoing continuous ambulatory peritoneal dialysis (CAPD). This retrospective cohort study included all incident CAPD patients treated at our center from 2006 to 2009. Demographic and clinical data on initiation of CAPD and clinical events during the study period were collected. Survival probabilities were generated using the Kaplan-Meier method, and risk factors for mortality were evaluated using Cox proportional hazards models. Of 805 patients on CAPD, the elderly group (≥65 years; mean age: 71.3 ± 4.3 years) consisted of 148 patients, and the younger group (<65 years; mean age: 43.1 ± 12.2years) consisted of 657 patients. The 1-, 2-, 3-, and 5-year patient survival rates were 97%, 92%, 88%, and 73% for the younger group, and 79%, 67%, 56%, and 30% for elderly group. The patient survival rates were significantly lower for the elderly group than for the younger group (p = 0.000). However, technique survival did not significantly differ between the groups (p = 0.559). In the patients overall, the independent predictors of death were old age (p = 0.003), diabetes (p = 0.000), cardiovascular disease (p = 0.006), lower hemoglobin (p = 0.010), and lower serum albumin (p = 0.024). Mortality in the elderly patients was associated with advanced age [relative risk (RR): 1.088; 95% confidence interval (CI): 1.027 to 1.153; p = 0.004], diabetes (RR: 2.064; 95% CI: 1.236 to 3.445; p = 0.006), and lower serum albumin (RR: 0.940; 95% CI: 0.897 to 0.985; p = 0.010). The elderly patients on CAPD experienced technique survival comparable with that of younger patients, but their patient survival was lower. In elderly patients, mortality was determined predominantly by greater age, diabetes, and lower serum albumin. Our results indicate that chronic peritoneal dialysis is a viable dialysis option for elderly patients with end-stage renal disease. Better management of hypoalbuminemia and comorbid conditions might improve survival in elderly PD patients.