Elderly dialysis patients: analysis of factors affecting long-term survival in 4-year prospective observation

Purpose

To assess factors influencing the long-term survival of elderly dialysis patients.

Methods

The study group consisted of 51 prevalent dialysis patients aged over 70?years (32 F and 19?M, all caucasians), who had been on a chronic hemodialysis (27) or peritoneal dialysis program (24) for at least 2?months; median age was 77?years, median time on dialysis before inclusion was 16?months, and median residual diuresis was 600?ml. The patients were prospectively followed up to 4?years, and an analysis of factors affecting survival was performed.

Results

Thirteen patients from the initial cohort of 51 (25.5?%) survived the whole 48-month observation period: 10 HD patients (37?%) and 3 PD patients (12.5?%). Annual mortality rate was 28.2?%: 37.4?% on PD vs. 20.9?% on HD. The dialysis modality had a significant impact on patients?? survival (p?=?0.049; Cox F-test). The independent mortality risk factors in the Cox proportional hazard regression model were higher plasma pro-atrial natriuretic peptide (pro-ANP) (p?=?0.006), lower residual diuresis (p?=?0.048), and lower systolic blood pressure (BP) value (p?=?0.039).

Conclusions

Paramount for the survival of the elderly on dialysis is adequate extracellular volume control. Residual renal function is a protective factor for the survival of elderly HD patients. This observation is novel, not previously reported in an elderly dialysis population.