The clinical status and survival in elderly dialysis: example of the oldest region of France.
Résumé
BACKGROUND: The number of elderly (>=75 years) patients with end-stage renal disease (ESRD) has increased markedly, including in the Limousin region, which has the oldest population in France. We retrospectively compared outcomes in elderly and non-elderly ESRD patients who started dialysis during two time periods. METHODS: Baseline clinical characteristics, care, and survival rates were assessed in 557 ESRD patients aged >=75 and <75 years who started dialysis in 2002--2004 and 2005--2007. Survival curves and Cox proportional hazards model were used to assess survival and factors associated with survival. RESULTS: Of the 557 patients, 343 and 214 were <75 years and >=75 years, respectively. Dialysis was started in 2002--2004 and 2005--2007 by 197 and 146 patients <75 years, respectively, and by 96 and 118 patients >=75 years, respectively. Median age (73.4 years [interquartile range [IQR] 61.7-79.5 years] vs 69.5 years [IQR 57.4-77.4 years] p = 0.001) and the proportion aged >=75 years (44.7% vs 32.8%, p = 0.004) were significantly higher in 2005--2007 than in 2002--2004. Improved initial status during 2005--2007 was observed only in patients >=75 years, with a decrease in some co-morbidities, improved walking and better preparation for dialysis. Mortality rates were significantly lower in 2005--2007 than in 2002--2004 (hazard ratio 0.81, 95% confidence interval 0.69-0.95; p = 0.008), with the difference due to factors associated with clinical status and care. CONCLUSIONS: Improved initial clinical status and better preparation for dialysis, accompanied by increased survival, were observed for patients >=75 years who started dialysis more recently, perhaps because of early referral to a nephrologist.