Early initiation of PD therapy in elderly patients is associated with increased risk of death

Abstract

Background The effect of early initiation of dialysis on outcomes of patients with end-stage renal disease (ESRD) remains controversial. We conducted this study to investigate the association between the timing of peritoneal dialysis (PD) initiation and mortality in different age groups. Methods In this single-centre cohort study, incident patients receiving PD from 1 January 2006 to 31 December 2016 were enrolled. Patients were categorized into three groups according to the estimated glomerular filtration rate (eGFR) at the initiation of PD, with early, mid and late initiation of PD defined as eGFR ≥7.5, 5–7.5 and <5 mL/min/1.73 m2, respectively. Results A total of 2133 incident patients receiving PD were enrolled with a mean age of 47.1 years, 59.6% male and 25.3% with diabetes, of whom 1803 were young (age <65 years) and 330 were elderly (age ≥65 years). After multivariable adjustment, the overall and cardiovascular (CV) mortality risks for young patients receiving PD were not significantly different between these three groups. However, for elderly patients, early initiation of PD therapy was associated with increased risks of all-cause {hazard ratio [HR} 1.54 [95% confidence interval (CI) 1.06–2.25]} and CV [HR 2.07 (95% CI 1.24–3.48)] mortality compared with late initiation of PD, while no significant difference was observed in overall or CV mortality between the mid- and late-start groups. Conclusions No significant difference in mortality risk was found among the three levels of eGFR at PD therapy initiation in young patients, while early initiation of PD was associated with a higher risk of overall and CV mortality among elderly patients.

The relationship between decline rate of residual renal function in the first year and mortality in peritoneal dialysis patients

“…A multicenter study involving 828 Initiating Dialysis Early and Late trial participants showed early commencement of dialysis in patients planning to start on PD does not confer a significant clinical benefit [35]. A cohort study found that early initiation of PD therapy in elderly patients is associated with increased risk of mortality in 2133 incident PD patients [36]. We speculated that patients with high baseline RRF commence early start dialysis refers harmful mainly due to accelerating loss of RRF, which can lead to volume loading, cardiac hypertrophy, imbalance of calcium and phosphorus metabolism, increased risk of peritonitis [11] and a decrease in energy-protein, increased complications of dialysis access and the need for higher doses of erythropoietin [34].…”

Risk factors of different mortality periods in older patients with end-stage renal disease undergoing urgent-start peritoneal dialysis: a retrospective observational study

“…Technical failure was regarded as the transition to hemodialysis for more than one month [ 21 ]. Cardiovascular diseases (CVD) included arrhythmias, cardiac arrest, acute myocardial infarction, congestive heart failure, cerebrovascular accident, or peripheral vascular disease [ 22 ]. Based on the New York Heart Association (NYHA) classification, cardiac function was classified into five levels: class 0 for no symptoms of heart failure; class I for no restriction of daily activities; class II for mild restriction of daily activities; class III for moderate restriction of daily activities; and class IV for resting symptoms of heart failure [ 23 ].…”

Home dialysis in older adults: challenges and solutions

“…Among older adults initiating on PD, similar findings have been noted. In a recent study, the risk of mortality was relatively higher for those initiating chronic dialysis at estimated glomerular filtration rate ≥7.5 versus <5 mL/min/1.73 m 2 [ 36 ]. While this may simply be a manifestation of indication bias (i.e.…”