Survival of elderly dialysis patients is predicted by both patient and practice characteristics

Celine Foote, Toshiharu Ninomiya, Martin Gallagher, Vlado Perkovic, Alan Cass, Stephen McDonald, Meg Jardine

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Increasing numbers of elderly patients facedecisions about the management of end-stage kidney disease. Improvedunderstanding of contemporary patient and practice factors influencingprognosis may assist decision making for individual patients and their careproviders.

    Methods: This is a prospective registry study using multivariable proportionalhazards models.

    Atotal of 1781 patients aged ≥75 years at dialysis initiation recorded inANZDATA, the Australia and New Zealand renal replacement registry, betweenJanuary 2002 and December 2005.

    Thepatient characteristics were demographic and comorbid conditions. The practicecharacteristics were late referral, access at dialysis initiation and intendeddialysis modality (modality established by 90 days).

    Thestudy outcome was mortality censored at 31 December 2007 or at recovery of renalfunction (of at least 30 days), transplantation or loss to follow-up.

    Results: Median follow-up was 2.3 years (interquartile range 1.1–3.3 years)during which time, 65% of the patients died. Baseline factors independentlyassociated with mortality were older age [hazard ratio (HR) 1.24 for 5-yearincrease, 95% confidence interval (CI) 1.13–1.36], body mass index <18.5 (HR1.78, 95% CI 1.33–2.38), number of comorbidities (one comorbidity HR 1.38, 95%CI 1.13–1.69; two comorbidities HR 1.55, 95% CI 1.27–1.89; three or morecomorbidities HR 1.89, 95% CI 1.55–2.31), late referral (HR 1.19, 95% CI1.02–1.39), peritoneal dialysis as intended modality (HR 1.26, 95% CI1.08–1.47) and unprepared access (HR 1.43, 95% CI 1.23–1.67).

    Thelimitations of the study were the observational nature of the analysis,potential selection bias introduced through analysis of a group who actuallycommenced dialysis and the potential confounding from unmeasured factors ordichotomous reporting of comorbidities.

    Conclusions: Within the elderly cohort, other patientcharacteristics have a greater association with mortality than 5-year ageincrements. Even after consideration of patient characteristics, practicefactors have a striking impact on the survival of elderly patients commencingdialysis. In the absence of randomized studies, efforts to enhance theidentification and preparation of elderly patients for dialysis may improveoutcomes within current settings.

    Original languageEnglish
    Pages (from-to)3581-3587
    Number of pages7
    JournalNephrology Dialysis Transplantation
    Volume27
    Issue number9
    DOIs
    Publication statusPublished - 2012

    Fingerprint

    Dialysis
    Survival
    Confidence Intervals
    Comorbidity
    Registries
    Mortality
    Referral and Consultation
    Selection Bias
    Peritoneal Dialysis
    New Zealand
    Chronic Kidney Failure
    Observational Studies
    Decision Making
    Body Mass Index
    Transplantation
    Demography
    Prospective Studies
    Kidney

    Cite this

    Foote, Celine ; Ninomiya, Toshiharu ; Gallagher, Martin ; Perkovic, Vlado ; Cass, Alan ; McDonald, Stephen ; Jardine, Meg. / Survival of elderly dialysis patients is predicted by both patient and practice characteristics. In: Nephrology Dialysis Transplantation. 2012 ; Vol. 27, No. 9. pp. 3581-3587.
    @article{f6af5c8a3d0045668222035792a785ef,
    title = "Survival of elderly dialysis patients is predicted by both patient and practice characteristics",
    abstract = "Background: Increasing numbers of elderly patients facedecisions about the management of end-stage kidney disease. Improvedunderstanding of contemporary patient and practice factors influencingprognosis may assist decision making for individual patients and their careproviders.Methods: This is a prospective registry study using multivariable proportionalhazards models.Atotal of 1781 patients aged ≥75 years at dialysis initiation recorded inANZDATA, the Australia and New Zealand renal replacement registry, betweenJanuary 2002 and December 2005.Thepatient characteristics were demographic and comorbid conditions. The practicecharacteristics were late referral, access at dialysis initiation and intendeddialysis modality (modality established by 90 days). Thestudy outcome was mortality censored at 31 December 2007 or at recovery of renalfunction (of at least 30 days), transplantation or loss to follow-up.Results: Median follow-up was 2.3 years (interquartile range 1.1–3.3 years)during which time, 65{\%} of the patients died. Baseline factors independentlyassociated with mortality were older age [hazard ratio (HR) 1.24 for 5-yearincrease, 95{\%} confidence interval (CI) 1.13–1.36], body mass index <18.5 (HR1.78, 95{\%} CI 1.33–2.38), number of comorbidities (one comorbidity HR 1.38, 95{\%}CI 1.13–1.69; two comorbidities HR 1.55, 95{\%} CI 1.27–1.89; three or morecomorbidities HR 1.89, 95{\%} CI 1.55–2.31), late referral (HR 1.19, 95{\%} CI1.02–1.39), peritoneal dialysis as intended modality (HR 1.26, 95{\%} CI1.08–1.47) and unprepared access (HR 1.43, 95{\%} CI 1.23–1.67).Thelimitations of the study were the observational nature of the analysis,potential selection bias introduced through analysis of a group who actuallycommenced dialysis and the potential confounding from unmeasured factors ordichotomous reporting of comorbidities.Conclusions: Within the elderly cohort, other patientcharacteristics have a greater association with mortality than 5-year ageincrements. Even after consideration of patient characteristics, practicefactors have a striking impact on the survival of elderly patients commencingdialysis. In the absence of randomized studies, efforts to enhance theidentification and preparation of elderly patients for dialysis may improveoutcomes within current settings.",
    author = "Celine Foote and Toshiharu Ninomiya and Martin Gallagher and Vlado Perkovic and Alan Cass and Stephen McDonald and Meg Jardine",
    year = "2012",
    doi = "10.1093/ndt/gfs096",
    language = "English",
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    pages = "3581--3587",
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    publisher = "Oxford University Press",
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    }

    Foote, C, Ninomiya, T, Gallagher, M, Perkovic, V, Cass, A, McDonald, S & Jardine, M 2012, 'Survival of elderly dialysis patients is predicted by both patient and practice characteristics', Nephrology Dialysis Transplantation, vol. 27, no. 9, pp. 3581-3587. https://doi.org/10.1093/ndt/gfs096

    Survival of elderly dialysis patients is predicted by both patient and practice characteristics. / Foote, Celine; Ninomiya, Toshiharu; Gallagher, Martin; Perkovic, Vlado; Cass, Alan; McDonald, Stephen; Jardine, Meg.

    In: Nephrology Dialysis Transplantation, Vol. 27, No. 9, 2012, p. 3581-3587.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Survival of elderly dialysis patients is predicted by both patient and practice characteristics

    AU - Foote, Celine

    AU - Ninomiya, Toshiharu

    AU - Gallagher, Martin

    AU - Perkovic, Vlado

    AU - Cass, Alan

    AU - McDonald, Stephen

    AU - Jardine, Meg

    PY - 2012

    Y1 - 2012

    N2 - Background: Increasing numbers of elderly patients facedecisions about the management of end-stage kidney disease. Improvedunderstanding of contemporary patient and practice factors influencingprognosis may assist decision making for individual patients and their careproviders.Methods: This is a prospective registry study using multivariable proportionalhazards models.Atotal of 1781 patients aged ≥75 years at dialysis initiation recorded inANZDATA, the Australia and New Zealand renal replacement registry, betweenJanuary 2002 and December 2005.Thepatient characteristics were demographic and comorbid conditions. The practicecharacteristics were late referral, access at dialysis initiation and intendeddialysis modality (modality established by 90 days). Thestudy outcome was mortality censored at 31 December 2007 or at recovery of renalfunction (of at least 30 days), transplantation or loss to follow-up.Results: Median follow-up was 2.3 years (interquartile range 1.1–3.3 years)during which time, 65% of the patients died. Baseline factors independentlyassociated with mortality were older age [hazard ratio (HR) 1.24 for 5-yearincrease, 95% confidence interval (CI) 1.13–1.36], body mass index <18.5 (HR1.78, 95% CI 1.33–2.38), number of comorbidities (one comorbidity HR 1.38, 95%CI 1.13–1.69; two comorbidities HR 1.55, 95% CI 1.27–1.89; three or morecomorbidities HR 1.89, 95% CI 1.55–2.31), late referral (HR 1.19, 95% CI1.02–1.39), peritoneal dialysis as intended modality (HR 1.26, 95% CI1.08–1.47) and unprepared access (HR 1.43, 95% CI 1.23–1.67).Thelimitations of the study were the observational nature of the analysis,potential selection bias introduced through analysis of a group who actuallycommenced dialysis and the potential confounding from unmeasured factors ordichotomous reporting of comorbidities.Conclusions: Within the elderly cohort, other patientcharacteristics have a greater association with mortality than 5-year ageincrements. Even after consideration of patient characteristics, practicefactors have a striking impact on the survival of elderly patients commencingdialysis. In the absence of randomized studies, efforts to enhance theidentification and preparation of elderly patients for dialysis may improveoutcomes within current settings.

    AB - Background: Increasing numbers of elderly patients facedecisions about the management of end-stage kidney disease. Improvedunderstanding of contemporary patient and practice factors influencingprognosis may assist decision making for individual patients and their careproviders.Methods: This is a prospective registry study using multivariable proportionalhazards models.Atotal of 1781 patients aged ≥75 years at dialysis initiation recorded inANZDATA, the Australia and New Zealand renal replacement registry, betweenJanuary 2002 and December 2005.Thepatient characteristics were demographic and comorbid conditions. The practicecharacteristics were late referral, access at dialysis initiation and intendeddialysis modality (modality established by 90 days). Thestudy outcome was mortality censored at 31 December 2007 or at recovery of renalfunction (of at least 30 days), transplantation or loss to follow-up.Results: Median follow-up was 2.3 years (interquartile range 1.1–3.3 years)during which time, 65% of the patients died. Baseline factors independentlyassociated with mortality were older age [hazard ratio (HR) 1.24 for 5-yearincrease, 95% confidence interval (CI) 1.13–1.36], body mass index <18.5 (HR1.78, 95% CI 1.33–2.38), number of comorbidities (one comorbidity HR 1.38, 95%CI 1.13–1.69; two comorbidities HR 1.55, 95% CI 1.27–1.89; three or morecomorbidities HR 1.89, 95% CI 1.55–2.31), late referral (HR 1.19, 95% CI1.02–1.39), peritoneal dialysis as intended modality (HR 1.26, 95% CI1.08–1.47) and unprepared access (HR 1.43, 95% CI 1.23–1.67).Thelimitations of the study were the observational nature of the analysis,potential selection bias introduced through analysis of a group who actuallycommenced dialysis and the potential confounding from unmeasured factors ordichotomous reporting of comorbidities.Conclusions: Within the elderly cohort, other patientcharacteristics have a greater association with mortality than 5-year ageincrements. Even after consideration of patient characteristics, practicefactors have a striking impact on the survival of elderly patients commencingdialysis. In the absence of randomized studies, efforts to enhance theidentification and preparation of elderly patients for dialysis may improveoutcomes within current settings.

    U2 - 10.1093/ndt/gfs096

    DO - 10.1093/ndt/gfs096

    M3 - Article

    VL - 27

    SP - 3581

    EP - 3587

    JO - Nephrology Dialysis Transplantation

    JF - Nephrology Dialysis Transplantation

    SN - 0931-0509

    IS - 9

    ER -