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Lookup NU author(s): Professor Neil SheerinORCiD
BACKGROUND: The number of elderly patients with chronic kidney disease (CKD) stage 5 is steadily increasing. Evidence is needed to inform decision-making for or against dialysis, especially in those patients with multiple comorbid conditions for whom dialysis may not increase survival. We therefore compared survival of elderly patients with CKD stage 5, managed either with dialysis or conservatively (without dialysis), after the management decision had been made, and explored which of several key variables were independently associated with survival. METHODS: A retrospective analysis of the survival of all over 75 years with CKD stage 5 attending dedicated multidisciplinary pre-dialysis care clinics (n = 129) was performed. Demographic and comorbidity data were collected on all patients. Survival was defined as the time from estimated GFR <15 ml/min to either death or study endpoint. RESULTS: One- and two-year survival rates were 84% and 76% in the dialysis group (n = 52) and 68% and 47% in the conservative group (n = 77), respectively, with significantly different cumulative survival (log rank 13.6, P < 0.001). However, this survival advantage was lost in those patients with high comorbidity scores, especially when the comorbidity included ischaemic heart disease. CONCLUSIONS: In CKD stage 5 patients over 75 years, who receive specialist nephrological care early, and who follow a planned management pathway, the survival advantage of dialysis is substantially reduced by comorbidity and ischaemic heart disease in particular. Comorbidity should be a major consideration when advising elderly patients for or against dialysis.
Author(s): Murtagh FE, Marsh JE, Donohoe P, Ekbal NJ, Sheerin NS, Harris FE
Publication type: Article
Publication status: Published
Journal: Nephrology Dialysis Transplantation
Year: 2007
Volume: 22
Issue: 7
Pages: 1955-1962
Print publication date: 01/07/2007
ISSN (print): 0931-0509
ISSN (electronic): 1460-2385
Publisher: Oxford University
URL: http://dx.doi.org/10.1093/ndt/gfm153
DOI: 10.1093/ndt/gfm153
Notes: Journal Article England official publication of the European Dialysis and Transplant Association - European Renal Association
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