Survival Analysis of Elderly Hemodialysis Patients in a Single Center

Song, Kyung Il; Kim, Su Hee; Maeng, Ju Hee; Choi, Jong Soo

Abstract

PURPOSE
The increased prevalence and incidence of end-stage renal disease (ESRD) in the elderly has become a worldwide phenomenon. New cases of ESRD are growing faster among people aged older than 70 years. We studied in order to investigate the survival rate, technical survival rate, causes of death and the predictors of death in patient starting hemodialysis aged over 70 years. METHODS: We analyze 34 patients who started hemodialysis as an initial replacement therapy for chronic renal failure in Kangnung Asan Hospital between July 1996 and July 2001. Demographic and clinical characteristics, including diabetes mellitus and laboratory findings at the beginning of hemodialysis were retrospectively analyzed. All subjects were followed up until the point of assessment, the time of death or withdrawal from dialysis. The survival rate was calculated by Kaplan-Meier method. In order to determine independent predictors of death, we used Cox proportional hazard model. RESULTS: The median age of the patients was 74.5 years and sex ratio was 2.4:1 (M:F). The most common cause of ESRD was diabetes (35.5%) and obstructive uropathy was second. The mean follow-up period was 18.6+/-2.5 months and cardiac problems were major causes of death (37.5%). The survival rate of 34 patients was 84.9% at 1 year, 72.8% at 2 year and 56.6% at 5 years. The technical survival rate of 34 patients was 54.7% at 1 year, 48.6% at 2 year and 30.1% at 4 years. The predictors of death were found to be (i) age starting hemodialysis (RR=1.685, p=0.018) (ii) female (RR=18.5, p=0.028) (iii) low initial hemoglobin level (RR 0.233, p=0.009). CONCLUSION: Very elderly ESRD patients on dialysis have a relatively good outcome and age is not barrier to dialysis. Measures to improve quality of life of elderly hemodialysis patients may favorably influence their survival.