Peritoneal Dialysis International, Vol. 31, pp. 663-671 doi: 10.3747/pdi.2010.00209
0896-8608/11 $3.00 + .00 Copyright © 2011 International Society for Peritoneal Dialysis
COMPARED WITH YOUNGER PERITONEAL DIALYSIS PATIENTS, ELDERLY PATIENTS HAVE SIMILAR PERITONITIS-FREE SURVIVAL AND LOWER RISK OF TECHNIQUE FAILURE, BUT HIGHER RISK OF PERITONITIS-RELATED MORTALITY Wai H. Lim,1,2 Gursharan K. Dogra,1 Stephen P. McDonald,2,3 Fiona G. Brown,2,4 and David W. Johnson2,5 Department of Renal Medicine,1 Sir Charles Gairdner Hospital, Perth; ANZDATA Registry,2 South Australia; Nephrology and Transplantation Services,3 The Queen Elizabeth Hospital, Adelaide; Department of Nephrology,4 Monash Medical Centre, Melbourne; and Department of Nephrology,5 University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
Perit Dial Int 2011; 31(6):663-671 www.PDIConnect.com epub ahead of print: 31 May 2011 doi:10.3747/pdi.2010.00209
Correspondence to: W.H. Lim, Department of Renal Medicine, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia 6009 Australia.
[email protected] Received 1 January 2011; accepted 17 January 2011
KEY WORDS: Elderly; peritonitis; technique survival; patient survival; registry; ANZDATA.
T
he number of elderly patients with end-stage kidney disease (ESKD) is increasing worldwide, resulting in a greater demand for renal replacement therapies. In Australia, the number of new elderly ESKD patients 65 years of age or older increased by 8% per annum to 1125 in 2008 from 860 in 2004 (1), mirroring a similar trend observed in other countries, including Canada and the United States (2,3). According to the US Renal Data System, the number of octogenarians and nonagenarians commencing dialysis increased by more than 6000 between 1996 and 2003, corresponding to an average annual increase of 10% of new dialysis starts (4). However, despite a rise in the acceptance of elderly patients for renal replacement therapy, the proportion of elderly patients commencing peritoneal dialysis (PD) is declining in many countries. Between 2006 and 2007 in Australia, new and prevalent elderly ESKD patients 65 years of age or older maintained on PD declined by 19% and 7% respectively (5). Similarly, in the United Kingdom, 21% of elderly patients 65 years of age or older commenced PD in 2002 compared with 42% of patients less than 65 years of age. By contrast, PD continues to be the preferred modality for elderly ESKD patients in other countries such as Hong Kong and France (6,7). Elderly ESKD patients often have age-related comorbidities, including cognitive deficits, poor visual acuity, impaired dexterity, immobility, anxiety, and depression, which may lead to a general reluctance to prescribe PD treatment in this group (8). In a recent report concerning incident elderly patients commencing PD (median age: 73 years), more than 15% of patients had comorbidities, including immobility and visual and hearing problems (9). Nevertheless, 40% of those patients were able to safely commence PD despite those limitations (9). Reluctance
This single copy is for your personal, non-commercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, contact Multimed Inc. at
[email protected]
663
Downloaded from http://www.pdiconnect.com/ by guest on December 23, 2015
♦ Background: The number of elderly patients with endstage kidney disease (ESKD) is increasing worldwide, but the proportion of elderly patients commencing peritoneal dialysis (PD) is falling. The reluctance of elderly ESKD patients to consider PD may be related to a perception that PD is associated with greater rates of complications. In the present study, we compared outcomes between younger and older PD patients. ♦ Methods: Using Australia and New Zealand Dialysis Registry data, all adult ESKD patients commencing PD between 1991 and 2007 were categorized into under 50, 50 – 64.9, and 65 years of age or older groups. Time to first peritonitis, death-censored technique failure, and peritonitis-associated and all-cause mortality were evaluated by multivariate Cox proportional hazards model analysis. ♦ Results: Of the 12 932 PD patients included in the study, 3370 (26%) were under 50 years of age, 4386 (34%) were 50 – 64.9 years of age, and 5176 (40%) were 65 years of age or older. Compared with younger patients (
