title: Outcomes in older adults with stage 5 chronic kidney disease: comparison of peritoneal dialysis and conservative management.
abstract: BACKGROUND
  Data on the outcomes of older adults receiving peritoneal dialysis (PD), especially those who are dependent and have multiple comorbidities, are scarce.
  
  
  METHODS
  In a retrospective cohort study, we compared older adults (≥65 years) with stage 5 chronic kidney disease receiving PD (PD group) with those receiving conservative management (conservative group). Baseline characteristics (demographics and clinical, functional, socioeconomic, and laboratory parameters) were collected, and study outcomes (patient survival, emergency hospitalization, institutionalization, and palliative and end-of-life care) were compared between groups.
  
  
  RESULTS
  We included 199 eligible participants aged 65-90 years (mean ± standard deviation 73.8 ± 5.4 years; 157 in the PD group and 42 in the conservative group). The PD group had a longer survival (median [interquartile range]: 3.75 [2.49-5.25] vs 2.35 [1.13-3.71] years, p < .001), lower emergency hospitalization rates (1.63 [0.82-2.92] vs 3.51 [1.06-7.16] per person-year, p < .01) and hospital days (16.17 [6.29-43.32] vs 38.01 [6.75-76.56] days per person-year, p = .03), and no increased risk of institutionalization compared with the conservative group. Age (hazard ratio [HR] for 1-year increase 1.06, 95% confidence interval [CI] 1.02-1.10), modified Charlson's Comorbidity Index (HR 1.36, 95% CI 1.18-1.56), impairment in basic activities of daily living (HR 2.11, 95% CI 1.28-3.46), and emergency dialysis (HR 1.67, 95% CI 1.11-2.53) were independent predictors of mortality in the PD group.
  
  
  CONCLUSIONS
  PD is a viable treatment option in older adults with stage 5 chronic kidney disease. Age alone should not preclude dialysis. Comprehensive geriatric assessment can prognosticate and facilitate shared decision making to commence dialysis in older adults.
authors.affiliation: MBBS, Division of Geriatrics, Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China. shum_ck@yahoo.com.hk.
authors.forename: Chun Keung
authors.initials: CK
authors.lastname: Shum
authors.forename: Kui Fu
authors.initials: KF
authors.lastname: Tam
authors.forename: Wai Leung
authors.initials: WL
authors.lastname: Chak
authors.forename: Tuen Ching
authors.initials: TC
authors.lastname: Chan
authors.forename: Ying Fai
authors.initials: YF
authors.lastname: Mak
authors.forename: Ka Foon
authors.initials: KF
authors.lastname: Chau
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D015577:Geriatric Assessment; D005919:Glomerular Filtration Rate / Q000502:physiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data; D008297:Male; D010166:Palliative Care / Q000706:statistics & numerical data; D010530:Peritoneal Dialysis / Q000379:methods*; D006435:Renal Dialysis / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000145:classification / Q000628:therapy*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Chronic kidney disease; Conservative management; Dialysis; Elderly; Outcome.