Survival of Elderly Patients on Maintenance Hemodialysis: A 6 Years? Experience from a Resource-Limited Country

Abstract

Background: With the improvement of life expectancy in developing countries, there is a growing population of elderly admitted on maintenance hemodialysis. This study assessed the survival among incident elderly patients on maintenance hemodialysis in Cameroon. Patients and method: We carried out a retrospective cohort study of 6.3 years in the main hemodialysis units of Cameroon. All incident chronic hemodialysis patients of at least 65 years of age at dialysis initiation were included. Participants were followed for a minimum of 4 months up until death or abandon of dialysis. Their baseline characteristics and survival outcome were assessed. Results: A total of 107 patients were included in this study, representing a cumulative incidence of hemodialysis among elderly patients of 10.9% during the study period. The median age at dialysis initiation was 68 years [IQR 66-72]. The median modified Charlson Comorbidity Index (mCCI) was 2 [IQR 2-5], and 35 (33%) patients had a comorbidity index greater than 3. Emergency dialysis at initiation was noted in 71 (69%) participants. Twenty four (22.5%) patients were hospitalized, mainly because of sepsis. The median survival time was 19.5 months [IQR 42-6]. Survival rates at 1 year and 2 year were 65.4% and 41.5%, respectively. The lowest survival time (4 months) was observed in the very elderly (> 80 years) with high comorbidity index. Patients with a history of hospitalization and those with emergency dialysis initiation also had low survival rates. Conclusion: In our setting, one out of ten incident hemodialysis patients is an elderly. Nearly two-thirds of elderly are still alive one year after hemodialysis initiation. Comorbidity, emergency dialysis initiation and hospitalization are the main factors associated with mortality.