[Relevant factors concerning phenomena related to the process of initiating dialysis in elderly patients with chronic renal failure: predicting the outcomes of subsequent phenomena at the stage of the initial phenomenon].
OBJECTIVE
We previously investigated the relevant factors concerning each individual phenomenon related to the process of initiating dialysis in elderly patients with chronic renal failure. Background factors that were identified as relevant factors were significant in terms of enabling us to predict the outcome of each phenomenon in new patients. However, the significance of these factors in predicting the outcomes of subsequent phenomena at the stage of the initial phenomenon was unclear. This was attributed to the fact that the subjects with phenomena decreased in number and because of changes in characteristics (hereafter, changes in subjects) with the progression of the process of initiating dialysis. In the present study, we aimed to identify relevant factors for predicting the outcomes of subsequent phenomena at the stage of the initial phenomenon. For this purpose, we assumed that "progression of the process of initiating dialysis does not result in significant reductions in the number of cases and causes only minor changes in characteristics".


METHODS
We studied a total of 152 patients with advanced chronic renal failure aged >or=60 years. Background factors were investigated in all patients. The following phenomena were analyzed: acceptance of dialysis, urgency of initiating dialysis, alleviation of disease, and returning home. In order to identify new relevant factors, we focused on the order and condition of the process by which each background factor was narrowed down during logistic regression analysis for each phenomenon. We determined which background factor to focus on for each phenomenon based on changes in background factors.


RESULTS
Age and cognitive function were related to the urgency of initiating dialysis and alleviation of disease. Age, walking ability, and cognitive function were related to returning home. Age was eliminated at the final stage of logistic regression analysis for alleviation of disease and at the penultimate stage of logistic regression analysis for returning home.


CONCLUSIONS
We simulated the restoration of cases lost during the process of initiating dialysis in order to determine the relationship of age to alleviation of disease as well as returning home. Although age significantly affected alleviation of disease, its relationship to returning home was unclear. Age was thus identified as a new relevant factor for alleviation of disease. In addition, all relevant factors identified from investigation of each phenomenon enabled prediction of outcomes of subsequent phenomena at the stage of the initial phenomenon.
Fujimaki
Hiroshi
H
Bureau of Social Welfare and Public Health, Tokyo Metropolitan Government.
Kasuya
Yutaka
Y
Kawaguchi
Sachiko
S
Hara
Shino
S
Koga
Shiro
S
Takahashi
Tadao
T
Mizuno
Shoichi
S
D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D010351:Patient Discharge; D006435:Renal Dialysis