P1469how Long Elderly Esrd Patients Can Undergo Dialysis Treatment?; A Nationwide Population-Based Cohort Study

Abstract

Background and Aims Elderly population is increasing and the age starting dialysis treatment is also increasing. It could be an ethical issue that we should do or not do start dialysis treatment in the oldest old people such as 10th decade. We investigated duration of dialysis therapy via patients age using National Health Insurance calim data to know dialysis survival of patients via their age. Method Korean National Health Insurance Database was used and excerpted data from the insurance claim of ICD code of dialysis. We included all new patients starting dialysis more than 3 months between 2004 and 2013 and compared dialysis duration among the age group. Patients on dialysis before 2003 were excluded, and patients on kidney transplantation were also excluded. Results Total 208,202 dialysis patients were included via dialysis insurance calim code from about 50,000,000 South Korean population during the year 2003 to 2015. 126,448 patients were excluded due to dialysis before 2003, < 3 months of dialysis duration, kidney transplatation, and to have missing data. Among the final 81,754 patients, 73,969 were hemodialysis and 7,785 were peritoneal dialysis. 47,798 were men and 33,956 were wemen. Observed median dialysis duration of each aged group of 20-40, 41-50, 51-60, 61-70, 71-80, 81-90, and >90 were 5.4 (2.2 - 18.3), 5.0 (1.8 - 17.7), 4.2 (1.5 - 15.1), 3.5 (1.2 - 12.6), 2.7 (0.9 - 10.1), 1.8 (0.5 - 7.1), 1.3 (0.3 - 4.9) years, respectively (p < 0.0001). Comparing with age under 40, dialysis survival hazard ratio of > 40, > 50, > 60, > 70, > 80, and > 90 were 1.493, 2.452, 3.762, 6.113, 9.787, and 15.326, respectively (p < 0.0001). Survival probability of the patients by the age was demonstrated in the figure 1. Lowest socio-econonic status and highest Charson-Comorbidity group showed highest hazard ratio of dialysis mortality, and peritoneal dialysis showed longer dialysis duration (HR 0.704, 95% CI of 0.69 - 0.74, p < 0.0001). Conclusion We concluded that dialysis durability by the age was rapidly decreased after 70 years old. As the longest patients survival of > 90 years were less than 5 years, we should consider patients’ general performance when starting dialysis of oldest old patients.