Abstract: [FR-OR043] Starting Dialysis at Age 75 Years or Older – Outcomes Data to Help in Shared Decision Making

Bjoerg Thorsteinsdottir, MD, Hanna L. W. Larson, LaTonya J. Hickson, MD, FASN, Molly A. Feely, MD, Amy W. Williams, MD. Medicine, Mayo Clinic, Rochester, MN; Univ of San Diego, San Diego, CA.
5:30 PM - 5:42 PM

Background: 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 renal replacement therapy (RRT) with several expressing regret of having initiated therapy. High HD withdrawal rates have been found in this group. Shared decision making regarding RRT in the elderly is hampered by the lack of evidence to guide practice in this age group. Methods: Review of the medical record for all patients 75 years and older, initiating any form of RRT at Mayo Clinic Jan 1, 2007 - Dec 31, 2011. Results: Of 390 patients, 66% were male, 94% were Caucasian, and mean age was 81.3 years (Interquartile range (IQR) 77.5-84.4), 40% had diabetes, and 27% had congestive heart failure. The mean Charlson comorbidity index was 7.9 (IQR 6-10). The majority, 290 (74%), started RRT in hospital. 147 (57%) began with continuous RRT in the ICU. Of 210 hospital-initiated patients admitted from independent living, only 70 (33%) were discharged home. Mean follow up was 17 months (range 0-74). Early mortality was high with 104 (27%) dying in less than 30 days and 140 (36%) dying in less than 90 days. The 6-month survival rate was 58% and 12 month survival 49% (Figure 1). Among hospital starters, 110 of 290 (38%) died during the index hospitalization.

Conclusions: This cohort study of elderly incident RRT patients suggests that most initiate RRT in the hospital following an illness or an event. Loss of independent living is frequently observed following hospitalization. Early and overall mortality is high. Patient awareness of these outcomes may allow for better informed discussions at time of RRT consideration.

Course: Annual Meeting: Abstract Sessions
Session: Geriatric Nephrology
Date/Time: Friday, November 8, 2013 4:30 PM - 6:30 PM
Location: Room 302

Individual author disclosures are available in the Kidney Week 2013 Disclosure Digest which is available to each meeting participant or upon request in November.

 

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