Survival of elderly dialysis patients is predicted by both patient and practice characteristics
Nephrology Dialysis Transplantation, Exclusive Author Commentary

Foote C et al. – Within the elderly cohort, other patient characteristics have a greater association with mortality than 5–year age increments. Even after consideration of patient characteristics, practice factors have a striking impact on the survival of elderly patients commencing dialysis. In the absence of randomized studies, efforts to enhance the identification and preparation of elderly patients for dialysis may improve outcomes within current settings.

• This analysis included 1781 people aged ?75 commencing dialysis in Australia and New Zealand. • 65% had died at a median of 1.5 years (interquartile range 0.66-2.50 years). • Most had timely nephrology referral (73%) but only 54% commenced dialysis with permanent access. • Survival was independently predicted by both patient and clinical practice variables. Older age, being underweight, and increasing number of co-morbid conditions were associated with mortality. Similarly, late referral, unprepared dialysis commencement, and peritoneal dialysis as chosen modality were also independently associated with mortality. • The presence of 3 or more comorbid conditions, and being unprepared for first dialysis both had a greater association with mortality than 5 year increments in age. • Little of the increased mortality associated with the lack of prepared dialysis access was explained by known patient characteristics, with the associated risk dropping only from 46% to 43% in the multivariable model. • Practice patterns may impact on survival and, in the absence of randomised evidence, serious consideration should be given to access preparation for elderly patients with advanced kidney disease who are likely to commence dialysis.

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