Incident elderly patients on peritoneal dialysis : epidemiological characteristics and modality impact on survival time

• Published in: Saudi journal of kidney diseases and transplantation Vol. 28; no. 4; pp. 782 - 791
• Main Authors: Franco, Marcia R. G., Bastos, Marcus G., Qurayshi, Abd R., Schreider, Alyne, Bastos, Kleyton de Andrade, Divino Filho, Jose C., Fernandes, Natalia M. S.
• Format: Journal Article
• Language: English
• Published: Riyadh, Saudi Arabia Saudi Center for Organ Transplantation 01-07-2017; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Subjects: Anemia; Automation; Blood pressure; Care and treatment; Comorbidity; Diabetes; Health aspects; Hemodynamics; Kidney diseases; Laboratories; Medicin och hälsovetenskap; Mortality; Nephrology; Patients; Peritoneal dialysis; Quality of life; Renal replacement therapy; Transplants & implants; Variables; المسنون; غسيل الكلى البريتوني
• ISSN: 1319-2442; 2320-3838

Aging of the population and the increased prevalence of diseases such as diabetes
and arterial hypertension result in an increasing need of dialysis treatment. Herein we describe a
cohort of elderly patients on peritoneal dialysis (PD) and assess the influence of the modality on
the long-term survival. Out of a multicenter prospective cohort of 2,144 BRAZPD PD incident
patients during a period from December 2004 to October 2007, 762 elderly adults, defined as
patients ≥65-year-old, were eligible for the study, 413 started on automated PD (APD) and 349 on
continuous ambulatory PD (CAPD). Patients were followed until death, transfer to hemodialysis,
recovery of renal function, loss to follow–up, or transplantation. Demographics and clinical data
were evaluated at baseline and described as mean ± standard deviation, median, or percentage.
Competing risk and time-dependent Cox analysis were performed, having dialysis modality APD]
vs. CAPD as a dependent variable, as hazard ratio (HR) is not proportional throughout the therapy
time. Mean age was 74.5 ± 6.8 years in APD, 74.6 ± 6.7 in CAPD, 50.8% females in APD, 54.4%
in CAPD. The frequently observed comorbidities were diabetes (52.3% in APD and 47% in
CAPD) and left ventricular hypertrophy (36.3% in APD and 46.1% in CAPD) whereas 93.6%
presented Davies score ≥2. In Cox time-dependent analysis, HR did not show difference up to 18
months HR = 1.11, confidence interval (CI) = 0.85–1.46], but thereafter, APD modality revealed
lower risk of mortality (HR = 0.25, CI = 0.0073–0.86), when compared with CAPD. After
adjustment for the confounding factors, CAPD presented a higher risk of mortality (HR = 4.50, CI
= 1.29–15.64). No differences in survival were observed up to 18 months of therapy; however,
beyond 18 months, APD modality was a protection factor