Abstract
ObjectivesSeveral studies have compared outcomes of peritoneal dialysis (PD) between elderly and non-elderly patients but with variable results. We hereby designed this review to compare mortality, peritonitis, and technique survival between elderly and non-elderly patients on PD.MethodsPubMed, Embase, and Google Scholar were searched for studies comparing outcomes of PD between elderly and non-elderly patients. The last search date was 14th July 2021.ResultsFourteen studies were included. 12 studies defined the elderly as ≥65 years of age and these were included in the meta-analysis. Pooled analysis of crude (RR: 2.45 95% CI: 1.36, 4.40 I2 = 97% p = 0.003) and adjusted data (HR: 2.80 95% CI: 2.45, 3.09 I2 = 0% p<0.00001) indicated a statistically significant increased risk of mortality amongst elderly patients as compared to non-elderly patients. Meta-analysis of four studies demonstrated a statistically significant increased risk of peritonitis in the elderly (RR: 1.56 95% CI: 1.18, 2.07 I2 = 76% p = 0.002). Pooled analysis demonstrated no statistically significant difference in technique survival between the two groups (RR: 0.95 95% CI: 0.86, 1.05 I2 = 86% p = 0.32).ConclusionElderly patients on PD have a significantly increased risk of mortality as compared to non-elderly patients. The risk of peritonitis is also significantly increased in older adults but the increased age has no impact on technique survival. Further studies are needed to strengthen our conclusions.
Highlights
Chronic renal disease is a major health problem with high incidence worldwide
The risk of peritonitis is significantly increased in older adults but the increased age has no impact on technique survival
According to a recent study, the global incidence of chronic renal disease is around 11–13% and majority of the patients are in stage 3 disease or above [1]
Summary
Chronic renal disease is a major health problem with high incidence worldwide. With improvement in healthcare facilities, life expectancy has increased worldwide and a large number of elderly patients are being diagnosed with end-stage renal disease (ESRD), with a need for dialysis. There are concerns amongst clinicians that the high burden of physical and cognitive impairment associated with older age could increase the risk of technique failure and mortality [4]. In this context, a large number of elderly patients rely on the support of family caregivers for initiating PD. The burden and risks of initiating home-based PD may still not be acceptable to all family members and caregivers which is why patients are still referred to in-center hemodialysis rather than home-based PD [5]
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