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

Abstract : 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.
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https://hal.univ-lorraine.fr/hal-01794180
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Submitted on : Thursday, May 17, 2018 - 12:41:20 PM
Last modification on : Sunday, October 25, 2020 - 7:06:45 AM

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Bernadette Faller, Jean-Baptiste Beuscart, Luc Frimat. Competing-risk analysis of death and dialysis initiation among elderly (≥80 years) newly referred to nephrologists: a French prospective study. BMC Nephrology, BioMed Central, 2013, 14 (1), pp.103. ⟨10.1186/1471-2369-14-103⟩. ⟨hal-01794180⟩

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