Very Old Patients on Hemodialysis: How They Start and Can We Predict Survival?

Background: We describe circumstances of dialysis initiation, dialysis prescription and factors affecting survival in elderly patients. Methods: We included all incident patients ≥ 80 years old from a National Registry for which clinical and laboratory data at dialysis initiation could retrospectively be obtained. Results: Of 170 patients included, 24% had diabetes, 30% ischemic heart disease, 13% peripheral arterial disease, 15% active malignancy and 60% prior nephrology care. Mean creatinine was 672 ± 225 μmol/l, eGFR 7.3 ± 3.7 ml/ min/1.73 m 2 , 81% started dialysis in hospital and 78% with a catheter. 32% had <2 sessions/week and 29% had singleneedle dialysis. One-year survival was 74% (median 26 months). In multivariate analysis only age (HR 1.10) and prior nephrology care (HR 0.48) were significant predictors of survival. Conclusions: The majority of elderly patients started dialysis with a catheter and in hospital setting. We estimate observed survival as good. Only age and prior nephrology care were independent predictors of survival. Video Journal Club ‘Cappuccino with Claudio Ronco’ at www. karger.com/?doi=367681. © 2014 S. Karger AG, Basel Received: April 1, 2014 Accepted: August 18, 2014 Published online: October 14, 2014 Assist. Prof. Jakob Gubensek, MD, PhD Department of Nephrology University Medical Center Ljubljana Zaloska cesta 7, SI–1000 Ljubljana (Slovenia) E-Mail jakob.gubensek @ kclj.si © 2014 S. Karger AG, Basel 0253–5068/14/0381–0074$39.50/0