Survival of elderly renal patients choosing either conservative management or renal replacement therapy


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W.R. Verberne, W. Bos

Voorzitter(s): prof. dr. M.M.H. Kramer, VUmc, Amsterdam & dr. C.G. Vermeij, Deventer Ziekenhuis

Woensdag 22 april 2015

15:00 - 16:00u in Zaal 0.5

Categorieën: parallelsessie (case reports/research)

Parallel sessie: Parallelsessie 4: Case reports/research

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Background:
The number of elderly patients with end-stage renal disease (ESRD) increases. Informed decision-making on renal replacement therapy (RRT) is an important part of nephrologists’ care. Patients with a poor prognosis on RRT may choose conservative management (CM). Adequate survival data, specifically of elderly patients, are needed for proper counselling. We compared survival of elderly renal patients treated either with CM or RRT.

Methods:
Retrospective single-centre cohort study (2005-2014) of ESRD patients aged ≥70 years (at the moment they opted for CM or RRT).

Results:
117 patients chose CM; 194 chose RRT. CM patients were older (mean 82.0 vs. 75.9 years, p < 0.001). The Davies comorbidity scores did not differ significantly between both groups. The overall median survival of elderly ESRD patients was longer on RRT when survival was calculated from the date of treatment decision and from the time eGFR p < 0.001). However, no significant survival advantage of RRT was observed in patients aged ≥80 years and in all patients aged ≥70 years with high Davies comorbidity scores (Davies score 3 or higher). There also was no survival advantage of RRT in patients aged ≥80 years with mild Davies comorbidity scores (Davies score 1-2).

Conclusion:
In this second largest cohort study reported so far, there is no survival advantage of RRT over CM in patients aged ≥80 years and in patients aged ≥70 years with high comorbidity. This provides important information for better decision-making in elderly patients with ESRD.