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 m2, 81% started dialysis in hospital and 78% with a catheter. 32% had < 2 sessions/week and 29% had single-needle 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.