Survival of patients ≥70 years with advanced chronic kidney disease: Dialysis vs. conservative care.
BACKGROUND
The number of elderly patients with advanced chronic kidney disease (ACKD) has increased in recent years, and the best therapeutic approach has not been determined due to a lack of evidence.


OBJECTIVE
To observe the progression of elderly patients with ACKD (stages 4 and 5) and to compare the survival of stage 5 CKD patients with and without dialysis treatment.


METHODS
All patients ≥70 years who began ACKD follow-up from 01/01/2007 to 31/12/2008 were included, and their progression was observed until 31/12/2013. Demographic data, the Charlson comorbidity index, history of ischaemic heart disease (IHD) and diabetes mellitus (DM) were assessed.


RESULTS
A total of 314 patients ≥70 years with stages 4 and 5 CKD were studied. Of these patients, 162 patients had stage 5 CKD at the beginning of follow-up or progressed to stage 5 during the study, and 69 of these patients were treated with dialysis. In the stage 5 group: median age was 77 years (74-81); 48% had IHD; 50% had DM, Charlson 7 (6-9). Kaplan-Meier survival analysis: ≥70 years (93 vs. 69 patients with dialysis, log rank: 15 P<.001); patients ≥75 years (74 vs. 46 patients with dialysis, log rank: 8.9 P=.003); patients ≥80 (40 vs. 15 patients with dialysis) and p=0,2. Patients receiving dialysis were younger, with a lower Charlson comorbidity index and shorter follow-up time.


CONCLUSIONS
Our study shows that dialysis treatment improves survival, although this benefit is lost in patients ≥80 years.
UGC Nefrología-Urología, Hospital Universitario Virgen del Rocío, Sevilla, España. Electronic address: yeleine_ma@hotmail.com.
Yeleine
Y
Martínez Echevers
UGC Nefrología-Urología, Hospital Universitario Virgen del Rocío, Sevilla, España.
Néstor Gabriel
NG
Toapanta Gaibor
UGC Nefrología-Urología, Hospital Universitario Virgen del Rocío, Sevilla, España.
Nathasha
N
Nava Pérez
UGC Nefrología-Urología, Hospital Universitario Virgen del Rocío, Sevilla, España.
Francisco
F
Barbosa Martin
UGC Nefrología-Urología, Hospital Universitario Virgen del Rocío, Sevilla, España.
Rafael
R
Montes Delgado
UGC Nefrología-Urología, Hospital Universitario Virgen del Rocío, Sevilla, España.
María Ángeles
MÁ
Guerrero Riscos
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D000072700:Conservative Treatment; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D017202:Myocardial Ischemia / Q000453:epidemiology; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies
Advanced chronic kidney disease; Ancianos; Conservative care; Elderly; Enfermedad renal crónica avanzada; Frail patient; Paciente frágil; Supervivencia; Survival; Tratamiento conservador