An assessment of survival among Korean elderly patients initiating dialysis: a national population-based study.
BACKGROUND
Although the proportion of the elderly patients with incident end-stage renal disease (ESRD) patients has been increasing in Korea, there has been a lack of information on outcomes of dialysis treatment. This study aimed to assess the survival rate and to elucidate predictors for all-cause mortality among elderly Korean patients initiating dialysis.


METHODS
We analyzed 11,301 patients (6,138 men) aged 65 years or older who had initiated dialysis from 2005 to 2008 and had followed up (median, 37.8 months; range, 3-84 months). Baseline demographics, comorbidities and mortality data were obtained using the database from the Health Insurance Review & Assessment Service.


RESULTS
The unadjusted 5-year survival rate was 37.6% for all elderly dialysis patients, and the rate decreased with increasing age categories; 45.9% (65∼69), 37.5% (70∼74), 28.4% (75∼79), 24.1% (80∼84), and 13.7% (≥85 years). The multivariate Cox proportional hazard model revealed that age, sex, dialysis modality, the type of insurance, and comorbidities such as diabetes mellitus, myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, chronic pulmonary disease, hemiparesis, liver disease, and any malignancy were independent predictors for mortality. In addition, survival rate was significantly higher in patients on hemodialysis compared to patients on peritoneal dialysis during the whole follow-up period in the intention-to-treat analysis.


CONCLUSIONS
Survival rate was significantly associated with age, sex, and various comorbidities in Korean elderly patients initiating dialysis. The results of our study can help to provide relevant guidance on the individualization strategy in elderly ESRD patients requiring dialysis.
Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
Shina
S
Lee
Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
Jung-Hwa
JH
Ryu
Department of Internal Medicine, Wonkwang University College of Medicine Sanbon Hospital, Gunpo, Korea.
Hyunwook
H
Kim
Department of Public Health, Graduate School, Korea University, Seoul, Korea.
Kyoung Hoon
KH
Kim
Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea.
Hyeong Sik
HS
Ahn
Ewha Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, Korea.
Hoo Jae
HJ
Hann
Ewha Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, Korea.
Yongjae
Y
Cho
Ewha Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, Korea.
Young Mi
YM
Park
Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
Seung-Jung
SJ
Kim
Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
Duk-Hee
DH
Kang
Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
Kyu Bok
KB
Choi
Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
Dong-Ryeol
DR
Ryu
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D056910:Republic of Korea / Q000453:epidemiology; D012737:Sex Factors; D015996:Survival Rate