Cost and Mortality Rate in Incident Elderly Hemodialysis Patients

Abstract

Objective: The demand for dialysis for elderly patients is increasing worldwide. The Comorbidity index is a predictor of mortality in dialysis patients but there are few reports for predicting elderly dialysis mortality and national populationbased cost studies on elderly dialysis. The purpose of the present study is to predict long-term survival of incident elderly hemodialysis patients using the Deyo-Charlson comorbidity index (CCI) in a nationwide cohort study and to evaluate the length of hospitalization and cost of treatment in this patient population. Method: Using the Registry for Catastrophic Illness Patient Database of the Taiwan National Health Insurance Research Database, we selected incident elderly dialysis patients (age ＞75 years) receiving hemodialysis for more than 90 days between Jan 1, 1998, and Dec 31, 2007, were included. Baseline comorbidities were determined one year prior to the first dialysis day according to ICD-9 CM codes. Survival time, mortality rate, hospitalization time, outpatient visit frequency, and costs were calculated for different age and CCI groups. Results: In 10,759 incident elderly hemodialysis patients, hazard ratios for all-cause mortality were significantly increased in the different age groups (p＜0.001) and CCI patients (p＜0.001). High comorbidity incident hemodialysis and elderly patients were found to have increased length of hospital stay and total hospitalization costs. Conclusion: Age and CCI scoring are useful for predicting long-term mortality in incident elderly hemodialysis patients. Increased length of hospital stay, low survival rate, and increased utilization of national health insurance was observed in higher comorbidity index elderly dialysis patients. These findings help to clarify the risks and benefits of hemodialysis in elderly patient populations and are informative for dialysis decision-making process. Conservative treatment might be considered for ESRD patients with high comorbidities and low survival rates.