Abstract
BackgroundElderly patients comprise the fastest growing population initiating dialysis in United States. The impact of poor functional status and pre-dialysis health status on clinical outcomes in elderly dialysis patients is not well studied.MethodsWe studied a retrospective cohort of 49,645 incident end stage renal disease patients that initiated dialysis between January 1, 2008 and December 31, 2008 from the United States Renal Data System with linked Medicare data covering at least 2 years prior to dialysis initiation. Using logistic regression models adjusted for pre-dialysis health status and other cofounders, we examined the impact of poor functional status as defined from form 2728 on 1-year all-cause mortality as primary outcome, type of dialysis modality (hemodialysis vs. peritoneal dialysis), and type of initial vascular access (arteriovenous access vs. central venous catheter) among hemodialysis patients as secondary outcomes.ResultsMean age was 72 ± 11 years. At dialysis initiation, 18.7% reported poor functional status, 88.9% had at least 1 pre-dialysis hospitalization, and 27.8% did not receive pre-dialysis nephrology care. In adjusted analyses, 1-year mortality was higher in patients with poor functional status (OR, 1.48; 95% CI, 1.40–1.57). Adjusted odds of being initiated on hemodialysis than peritoneal dialysis (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.16–1.66) were higher in patients with poor functional status. Poor functional status decreased the adjusted odds of starting hemodialysis with arteriovenous access as compared to central venous catheter (OR, 0.79; 95% CI, 0.72–0.86).ConclusionPoor functional status in elderly patients with end stage renal disease is associated with higher odds of initiating hemodialysis; increases the risk of central venous catheter use, and is an independent predictor of 1-year mortality.
Highlights
Patients comprise the fastest growing population initiating dialysis in United States
Elderly chronic kidney disease (CKD) patients defined as ≥60 years of age represent the fastest growing segment of the incident end stage renal disease (ESRD) population in United States, with more than half of incident dialysis patients being over 65 years of age [1]
Using logistic regression models adjusted for pre-dialysis health status and other covariates, we examined the impact of poor functional status on hemodialysis vs. Peritoneal dialysis (PD) and in separate model among hemodialysis patients; we studied the effect of functional status on AV access vs. CVC
Summary
Patients comprise the fastest growing population initiating dialysis in United States. The impact of poor functional status and pre-dialysis health status on clinical outcomes in elderly dialysis patients is not well studied. Chronic kidney disease (CKD) patients defined as ≥60 years of age represent the fastest growing segment of the incident end stage renal disease (ESRD) population in United States, with more than half of incident dialysis patients being over 65 years of age [1]. Comorbidities and acute care hospitalizations are frequent in elderly CKD patients, may lead to poor pre-dialysis health, and independently increase the risk of death [9,10,11]. Studies have examined clinical outcomes of elderly dialysis patients, the impact of functional status and pre-dialysis health including pre-dialysis acute hospitalization at incident dialysis on post-ESRD outcomes has not been studied
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