Abstract
Introduction The worldwide elderly (≥65 years old) dialysis population has grown significantly and is expected to have more comorbid conditions and shorter life expectancies than the general elderly population. Predicting outcomes for this population is important for decision-making. There are some studies about comorbidity scoring systems for predicting survival in dialysis patients. To establish a simple and practicable scoring system for predicting survival in the elderly population is increasingly important for physicians worldwide. The aim of this critical review was to discuss the comorbidity scoring systems for predicting survival in elderly dialysis patients and additional management strategies. Conclusion Of the current comorbidity scoring systems for predicting survival in dialysis patients, the Charlson comorbidity index is considered the most predictive one than any other commonly used comorbidity scoring systems. Recently, a new comorbidity index with good predictive value for patient outcomes was developed and validated in chronic dialysis patients. The new comorbidity index, even without the age component, is a strong predictor of mortality in elderly dialysis patients. Using one or both of these scoring systems, a physician may be able to provide some helpful objective opinions and suggestions to elderly patients who must choose between initiating and not initiating dialysis.
Highlights
The worldwide elderly (≥65 years old) dialysis population has grown significantly and is expected to have more comorbid conditions and shorter life expectancies than the general elderly population
The “age” factor is a strong predictor of mortality in many studies[4,5]
The prevalence of different comorbidities in elderly dialysis patients From the National Health Insurance Research Database (NHIRD) data, 51.5% of the elderly dialysis patients in Taiwan were in a low the new comorbidity index (nCI) score group (≤3)
Summary
The CCI is considered the most predictive than other commonly used comorbidity scoring systems. The nCI, even without the age component, is a strong predictor of mortality in elderly dialysis patients. The elderly dialysis population (especially ≥70 years) with low nCI scores (i.e., few comorbidities) may have acceptable mean life expectancy. Aggressive dialysis rather than conservative care should be considered preferentially in this population, especially in patients without obvious functional impairments. Using one or both of these scoring systems, a physician may be able to provide some helpful objective opinions and suggestions to elderly patients who must choose between initiating and not initiating dialysis. Abbreviations list CCI, Charlson comorbidity index; ICED, index of co-existent diseases (ICED); nCI, the new comorbidity index; NHIRD, the Taiwan National Health Insurance Research Database; RPA/ASN, the Renal Physicians Association and the American Society of Nephrology
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