Cohort study with patients older than 80 years with stage 5 chronic kidney failure on hemodialysis vs conservative treatment: Survival outcomes and use of healthcare resources

Abstract

Renal replacement treatment has not been generalized to the elderly for different reasons. The main objective of the present cohort study is to compare survival in patients older than 80 years with chronic kidney disease stage 5 on renal replacement treatment with those on conservative treatment. The use of healthcare resources is compared too. A Cox proportional hazards regression analysis was run with the outcome variable death during the follow‐up period. The independent variables were treatment type, age, gender, smoking habit, serum albumin, hemoglobin, Charlson Index, diabetes mellitus, arterial hypertension, ischemic cardiopathy, and neoplasm. For outcome variable “death,” renal replacement treatment obtained a hazard ratio of 0.273 (P .006, CI95% 0.108‐0.686) vs conservative treatment. In conclusion, patients older than 80 years with chronic kidney disease stage 5 on renal replacement treatment presented a lower mortality risk than those receiving conservative treatment. Comorbidity and age are both associated with mortality, but do not cancel out the survival advantage. In healthcare resources, the renal replacement treatment group made greater use of tests, medical visits and consumption of hospital dispensing drugs, but there were no differences with respect to the days of hospital admission or assistance in home hospitalization.

Survival of patients who opt for dialysis versus conservative care: a systematic review and meta-analysis

“…Table 1 presents the characteristics of the 22 included studies [ 21–42 ]. The sample size varied from 87 [ 42 ] to 14 071 [ 40 ] patients, resulting in a total of 21 344 patients. The proportion of patients opting for CC varied between 6% and 77% (median 31%) [ 35 , 40 ].…”

“…The proportion of patients opting for CC varied between 6% and 77% (median 31%) [ 35 , 40 ]. The majority of the studies were restricted in age, ranging from ≥65 to ≥80 years old [ 18 , 21 , 23 , 26 , 27 , 30 , 31 , 33–37 , 39 , 41 , 42 ]. The mean age in the studies ranged from 61 to 86 years (median 78).…”

“…The reference point for survival analysis in most studies was the time when eGFR decreased to <15 mL/min/1.73 m 2 ( n = 10) [ 21 , 24 , 29 , 32 , 35–38 , 40 , 42 ], followed by eGFR <10 mL/min/1.73 m 2 or putative dialysis start ( n = 6) [ 23 , 25 , 27 , 28 , 31 , 34 ], eGFR <20 mL/min/1.73 m 2 ( n = 1) [ 30 ] and treatment decision ( n = 1) [ 41 ]. Four studies assessed multiple starting points for their survival analyses [ 22 , 26 , 33 , 39 ].…”

“…In 11 studies, results were not adjusted for age and comorbidity status [ 23 , 25 , 27–30 , 33–35 , 38 , 40 ]. Seven studies were of serious or critical risk of selection bias [ 25–27 , 31 , 34 , 40 , 42 ], as the start of follow-up probably did not coincide for the included patients, leading to a risk of lead time or immortal time bias. The risk of bias due to unclear classification of interventions was considered serious in two studies where the intervention was not well-defined [ 25 , 42 ].…”

“…Seven studies were of serious or critical risk of selection bias [ 25–27 , 31 , 34 , 40 , 42 ], as the start of follow-up probably did not coincide for the included patients, leading to a risk of lead time or immortal time bias. The risk of bias due to unclear classification of interventions was considered serious in two studies where the intervention was not well-defined [ 25 , 42 ]. The risk of bias on missing data often could not be assessed, because nine studies lacked a statement on the number of patients lost to follow-up or missing data [ 21 , 22 , 25–27 , 29 , 32 , 38 , 39 , 41 ].…”