04 Nov Elderly Frail Patients At Higher Risk Of Mortality After Dialysis Initiation
MedicalResearch.com Interview with:
Silvi Shah, MD, FACP, FASN
Assistant Professor, Division of Nephrology
University of Cincinnati
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Elderly represent the fastest growing segment of incident dialysis patients in Unites States. The annual mortality in end stage renal disease (ESRD) patients is very high ~ 20%. Since most of the deaths occur in the first year of dialysis, it is possible that health conditions present prior to initiation of dialysis may impact long-term outcomes.
In this study, we determined the impact of poor functional status at the time of dialysis initiation and pre-dialysis health status on type of dialysis modality, type of hemodialysis access and one-year mortality in elderly dialysis patients. We evaluated 49,645 adult incident dialysis patients (1/1/2008 to 12/31/2008) from the United Data Renal Data System (USRDS) with linked Medicare data for at least 2 years prior to dialysis initiation. Mean age of our study population was 72 years. At dialysis initiation, 18.7% reported poor functional status, 88.9% has pre-dialysis hospitalization, and 27.8% did not receive pre-dialysis nephrology care. Patients with poor functional status had higher odds of being initiated on hemodialysis than peritoneal dialysis, lower odds of using arteriovenous access as compared to central venous catheter for dialysis and higher risk of one-year mortality.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Large number of elderly dialysis patients have poor functional status during dialysis initiation. Elderly patients with poor functional status also have more co-morbidities, received less pre-dialysis nephrology care and had higher pre-dialysis hospitalizations as compared to those with good functional status.
In our study, poor functional status was associated with 48% higher risk of adjusted mortality after adjusting for pre-dialysis health status. This should be kept in mind while evaluating elderly patients with kidney disease for dialysis initiation. Patients with poor functional status should be counseled for shared decision making and assessed for conservative treatment option.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: In future, we would further like to evaluate if the intervention of physical rehabilitation in elderly dialysis patients with poor functional status impacts their survival in the long run. Another area of research would be to study the disparities across race and gender in patients with poor functional status who get initiated on dialysis.
MedicalResearch.com: Is there anything else you would like to add?
Response: I would like to thank my entire team at University of Cincinnati who participated in the project. The research was supported by intramural funds of Division of Nephrology, Kidney CARE Program, University of Cincinnati.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Shah, Silvi, Leonard, Anthony C, Thakar, Charuhas V
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.