Competing-risk analysis of death and dialysis initiation among elderly (≥80 years) newly referred to nephrologists: a French prospective study

BMC Nephrology

Luc Frimat²  Jean-Baptiste Beuscart¹  Bernadette Faller³ 

[1]Department of biostatistics, EA 2694, UDSL, Lille, France

[2] Geriatric Department, University Hospital, Lille, France

[3]Nancy University, P. Verlaine Metz University, and Paris Descartes University, EA 4360 Apemac, Nancy, France

[4]Department of Nephrology, Hôpital Louis Pasteur, Colmar, France

关键词: Competing-risk analysis;    Elderly;    Conservative management;    Renal replacement therapy;    Chronic kidney disease;   

Others  :  1082936
DOI  :  10.1186/1471-2369-14-103

 received in 2012-11-02, accepted in 2013-04-25,  发布年份 2013

【 摘 要 】

Background

Reasons underlying dialysis decision-making in Octogenarians and Nonagenarians have not been further explored in prospective studies.

Methods

This regional, multicentre, non-interventional and prospective study was aimed to describe characteristics and quality of life (QoL) of elderly (≥80 years of age) with advanced chronic kidney disease (stage 3b-5 CKD) newly referred to nephrologists. Predictive factors of death and dialysis initiation were also assessed using competing-risk analyses.

Results

All 155 included patients had an estimated glomerular filtration rate (eGFR) below 45 ml/min/1.73 m². Most patients had a non anaemic haemoglobin level (Hb) with no iron deficiency, and normal calcium and phosphate levels. They were well-fed and had a normal cognitive function and a good QoL. The 3-year probabilities of death and dialysis initiation reached 27% and 11%, respectively. The leading causes of death were cardiovascular (32%), cachexia (18%), cancer (9%), infection (3%), trauma (3%), dementia (3%), and unknown (32%). The reasons for dialysis initiation were based on uncontrolled biological abnormalities, such as hyperkalemia or acidosis (71%), uncontrolled digestive disorders (35%), uncontrolled pulmonary or peripheral oedema (29%), and uncontrolled malnutrition (12%). No patients with acute congestive heart failure or cancer initiated dialysis. Predictors of death found in both multivariate regression models (Cox and Fine & Gray) included acute congestive heart failure, age, any walking impairment and Hb <10 g/dL. Regarding dialysis initiation, eGFR <23 mL/min/1.73 m² was the only predictor found in the Cox multivariate regression model whereas eGFR <23 mL/min/1.73 m² and diastolic blood pressure were both independently associated with dialysis initiation in the Fine & Gray analysis. Such findings suggested that death and dialysis were independent events.

Conclusions

Octogenarians and Nonagenarians newly referred to nephrologists by general practitioners were highly selected patients, without any symptoms of the common geriatric syndrome. In this population, nephrologists’ dialysis decision was based exclusively on uremic criteria.

【 授权许可】

   
2013 Faller et al.; licensee BioMed Central Ltd.

【 图 表 】

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