Dialysis improves survival for elderly with kidney failure – for an initial three-year period
Compared to younger patients, older adults with advanced chronic kidney disease experience higher morbidity and mortality and are more likely to die than to progress to kidney failure requiring renal replacement therapy.
However, the impact of dialysis on survival is not clear, as comparisons of survival between dialysis and non-dialysis care for older adults with kidney failure are vulnerable to lead and immortal time biases, reports a group of Canadian researchers (Tam-Tham H et al, Survival among older adults with kidney failure is better in the first three years with chronic dialysis treatment than not. Kidney Int. 2018;94:582-588). The aim of their retrospective cohort study was to compare time to all-cause mortality among older adults with kidney failure who are either treated or not treated with chronic dialysis.
838 patients (mean age 79.1 years; 48.6% male) met the inclusion criteria of kidney failure: two or more consecutive outpatient estimated glomerular filtration rates <10 mL/min/1.73m2, spanning 90 or more days.
The main result was that dialysis treatment (vs. no dialysis) was associated with a significantly lower risk of death for the first three years of follow-up (hazard ratio 0.59 [95% confidence interval 0.46-0.77]), but not after these first three years (1.22 [0.69-2.17]). On the other hand, dialysis was associated with a significantly higher risk of hospitalization (1.40 [1.16-1.69]).
So elderly patients who receive dialysis have a longer survival of up to three years after reaching kidney failure, but the survival benefit was no longer apparent after three years, and was also offset by a higher risk of hospital admissions. The authors hope that these findings will aid clinicians in their decision-making process in the treatment of kidney failure in the elderly.
Link to the study: https://www.kidney-international.org/article/S0085-2538(18)30246-1/fulltext