Patients Aged 75+ Have Poor Outcomes After Starting RRT

ATLANTA—Early and overall mortality is high among patients who start renal replacement therapy (RRT) at age 75 years and older, according to data presented at the American Society of Nephrology's Kidney Week 2013.

Bjoerg Thorsteinsdottir, MD, of Mayo Clinic, Rochester, Minn., and collaborators reviewed medical records of 379 patients aged 75 years and older starting any form of RRT at the Mayo Clinic Rochester Midwest dialysis network. The group was 66% male, 93% Caucasian. The mean age was 80.8 years. In this group, 27% had diabetes and 32% had congestive heart failure. The mean Charlson comorbidity index was 7.7.

Of the 379 patients, 286 (76%), started RRT in hospital after an acute illness or surgery. A total of 173 (60%) of those began with continuous RRT in the intensive care unit. Of 254 hospital-initiated patients admitted from independent living, only 95 (37%) were discharged home, the investigators reported. The mean follow up was 17 months (range 0-74).

One hundred and four patients (27%) died in fewer than 30 days and 140 (36%) died in fewer than 90 days. The six- and 12-month survival rates were 60%% and 49%, respectively. Among the patients who started RRT in the hospital, 110 (43%) died during the index hospitalization.

In their study abstract, Dr. Thorsteinsdottir's group observed that the “intensity of medical care for the oldest old has escalated beyond population growth in the past decades driven by powerful moral and technological imperatives to treat.” Many elderly patients and their families feel that they have no choice but to start RRT, some expressing regret of having initiated therapy.

“Shared decision making regarding RRT in the elderly is hampered by the lack of evidence to guide practice in this age group,” the authors wrote.

Patient awareness of the outcomes demonstrated in the study “may allow for better informed discussions at the time of RRT consideration.”

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