Abstract
BackgroundThe optimal timing for initiating dialysis in end-stage renal disease (ESRD) is controversial, especially in the elderly.Methods665 patients ≥65 years old who began dialysis from August 2008 to February 2015 were prospectively enrolled in the Clinical Research Center for End-Stage Renal Disease cohort study. Participants were divided into 2 groups based on the median estimated glomerular filtration rate at the initiation of dialysis. Propensity score matching (PSM) was used to compare the overall survival rate, cardiovascular events, Kidney Disease Quality of Life Short Form 36 (KDQOL-36) results, Karnofsky performance scale values, Beck’s depression inventory values, and subjective global assessments.ResultsThe mean patient age was 72.0 years, and 61.7% of the patients were male. Overall, the cumulative survival rates were lower in the early initiation group, although the difference was not significant after PSM. Additionally, the survival rates of the 2 groups did not differ after adjusting for age, sex, Charlson comorbidity index and hemoglobin, serum albumin, serum calcium and phosphorus levels. Although the early initiation group showed a lower physical component summary score on the KDQOL-36 3 months after dialysis, the difference in scores was not significant 12 months after dialysis. Furthermore, the difference was not significant after PSM. The Karnofsky performance scale, Beck’s depression inventory, and subjective global assessments were not significantly different 3 and 12 months after dialysis initiation.ConclusionsThe timing of dialysis initiation is not associated with clinical outcomes in elderly patients with ESRD.
Highlights
Individuals represent the fastest-growing population of incident dialysis patients worldwide [1,2,3]
The cumulative survival rates were lower in the early initiation group, the difference was not significant after Propensity score matching (PSM)
The timing of dialysis initiation is not associated with clinical outcomes in elderly patients with end-stage renal disease (ESRD)
Summary
Individuals represent the fastest-growing population of incident dialysis patients worldwide [1,2,3]. Initiation strategies have been supported since 1995 [5], and conventional wisdom indicates that delaying dialysis is potentially dangerous. Specific criteria for dialysis initiation are not available for elderly patients, until the late 2000s, treatment was initiated in the earlier stages of kidney dysfunction, which is similar to the procedure for other age groups [6]. The importance of a palliative approach is emphasized in the elderly end-stage renal disease (ESRD) population because of the burden of treatment and its negative effect on quality of life (QOL). The optimal timing for initiating dialysis in end-stage renal disease (ESRD) is controversial, especially in the elderly
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