Elderly Peritoneal Dialysis Compared with Elderly Hemodialysis Patients and Younger Peritoneal Dialysis Patients: Competing Risk Analysis of a Korean Prospective Cohort Study.

Hyunsuk Kim,Myoung-Hee Kim,Chun Soo Lim,Yong-Lim Kim,Yun Kyu Oh,Jung Pyo Lee,Yon Su Kim,Ho Kim,Ki Soo Park,Jung Nam An,Dong Ki Kim,Crc For Esrd Investigators

doi:10.1371/journal.pone.0131393

Abstract

The outcomes of peritoneal dialysis (PD) in elderly patients have not been thoroughly investigated. We aimed to investigate the clinical outcomes and risk factors associated with PD in elderly patients. We conducted a prospective observational nationwide adult end-stage renal disease (ESRD) cohort study in Korea from August 2008 to March 2013. Among incident patients (n = 830), patient and technical survival rate, quality of life, and Beck’s Depression Inventory (BDI) scores of elderly PD patients (≥65 years, n = 95) were compared with those of PD patients aged ≤49 years (n = 205) and 50~64 years (n = 192); and elderly hemodialysis (HD) patients (n = 315). The patient death and technical failure were analyzed by cumulative incidence function. Competing risk regressions were used to assess the risk factors for survival. The patient survival rate of elderly PD patients was inferior to that of younger PD patients (P<0.001). However, the technical survival rate was similar (P = 0.097). Compared with elderly HD patients, the patient survival rate did not differ according to dialysis modality (P = 0.987). Elderly PD patients showed significant improvement in the BDI scores, as compared with the PD patients aged ≤49 years (P = 0.003). Low albumin, diabetes and low residual renal function were significant risk factors for the PD patient survival; and peritonitis was a significant risk factor for technical survival. Furthermore, low albumin and hospitalization were significant risk factors of patient survival among the elderly. The overall outcomes were similar between elderly PD and HD patients. PD showed the benefit in BDI and quality of life in the elderly. Additionally, the technical survival rate of elderly PD patients was similar to that of younger PD patients. Taken together, PD may be a comparable modality for elderly ESRD patients.

Highlights

In recent decades, the prevalence and the incidence of elderly patients undergoing renal replacement therapy (RRT) have been continuously increasing [1]
For dialysis candidates with end-stage renal disease (ESRD), it is critical to determine whether peritoneal dialysis (PD) or hemodialysis (HD) is more effective, as it may directly affect the survival rate and quality of life (QOL) of these patients [9]
PD patients were divided to 3 groups according to age; the proportion of men according to age groups was not different (P = 0.271)

Summary

Introduction

The prevalence and the incidence of elderly patients undergoing renal replacement therapy (RRT) have been continuously increasing [1]. The management in elderly patients with end-stage renal disease (ESRD) includes RRT such as kidney transplantation [2, 3], dialysis, as well as maximal conservative management [3,4,5]. Choosing modality in the elderly is more difficult because clinicians have to base their choice between the complexity of co-morbidity [7] and cost or quality of life (QOL) [8]. For dialysis candidates with ESRD, it is critical to determine whether peritoneal dialysis (PD) or hemodialysis (HD) is more effective, as it may directly affect the survival rate and QOL of these patients [9]. In Korea, incident PD patients are decreasing, as compared to HD patients [12, 13]

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Conclusion