P1222CLINICAL OUTCOMES AND MORTALITY IN PERITONEAL DIALYSIS: WHAT ABOUT ELDERLY PATIENTS?

Abstract

Abstract Background and Aims The burden of elderly patients initiating dialysis regimens is increasing around the world due to rising life expectancies. However, little is known regarding the results of elderly patients treated with peritoneal dialysis (PD). Thus, the aim of this study is to determine the clinical outcomes and to evaluate the survival rates as well as the predictors of mortality among this group. Method This is a retrospective descriptive study performed in the PD unit in Monastir - Tunisia from 1990 till december 2017. All patients aged ≥ 65 years were included. The epidemiological and clinico-biological data as well as the complications were collected. Overall and technique survival rates were analyzed. Results Of the total 304 patients who began PD during the study period, 55 met our inclusion criteria. The prevalence of elderly patients was 18.1%. The mean age was 73 ± 5 years (65-86) with a male predominance (65.5%). Our patients were diabetic, hypertensive and cardiac in 45%, 64% and 33% respectively. Histories of hemodialysis necessity prior to PD use were present in 43.6 % of the patients. PD exchanges were performed by a member of the family in for 87.3% of cases and they often choose the CAPD (80%). Peritonitis rate was 17.92 patient-months. During the follow-up period, transfers to hemodialysis (15 patients) and death (39 patients) were the most common causes of withdrawal from PD. Frequent peritonitis, ultrafiltration failure warranted transfers to hemodialysis in 27% and 40% respectively. Causes of death were mostly not related to PD (87.2%) and they included cardiovascular events (28.2%), sepsis (20.5%) as well as neoplasma (15.4%). The mean patient survival time was 16.4 years versus 23.3 years in the other group. The survival rates were 96%, 93.5%, 86.9% and 76.6% at 1, 3, 5 and 10 years after peritoneal dialysis initiation, respectively. Advanced age (p 0.04) and occurrence of peritonitis (p 0.02) were predictors of mortality. The mean technique survival duration was 48.6±2.7 months. The technique survival rates were 78%, 62.6%, 53.5% and 41% at 1, 2, 3 and 4 years, respectively. Peritonitis was the primordial predictor of technique survival. Conclusion Mortality among elderly patients seems to be higher in our study. Infectious complications and cardiovascular events were the main causes of death. Advanced age and occurence of peritonitis represented the main predictive factors of mortality.