Open AccessOptimization of treatment modality in elderly end-stage renal disease population: Peritoneal dialysis versus transplant
Author(s) -
Anupama Kaul,
Behera,
Raj Kishore,
B. Karthikeyan,
D Bhadauria,
Prabhaker Mishra,
Narayan Prasad,
Amit Gupta,
RK Sharma
Publication year - 2018
Publication title -
indian journal of nephrology/indian journal of nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.317
H-Index - 24
eISSN - 1998-3662
pISSN - 0971-4065
DOI - 10.4103/ijn.ijn_305_17
Subject(s) - medicine , peritoneal dialysis , hazard ratio , dialysis , end stage renal disease , population , confidence interval , transplantation , surgery , retrospective cohort study , proportional hazards model , hemodialysis , environmental health
Despite kidney transplantation (KT) being considered as the best treatment modality for end-stage renal disease (ESRD), patient and graft survival in the elderly population is poorer than younger individuals. Many authors argue that prolonged life expectancy outweighs the risk of remaining on dialysis, but few studies had compared the treatment modalities, especially with peritoneal dialysis (PD). A retrospective study was conducted at a tertiary care institute to compare outcome of elderly ESRD patients, who received KT with those continued on PD; and to evaluate the predictors of patient survival. Patient survival at 1 year was (76.2% vs. 91.1%); 5 years (53.7% vs. 21.8%); and 10 years (35.6% vs. 0.00%) among KT and PD population, respectively. Infection was the most common cause of death among KT group (35 [41.2%] vs. 34 [28.2%]) while cardiovascular mortality in PD group (55 [46.2%] vs. 7 [8.2%]). Technique survival at 1, 5, and 10 years in PD group was 92.8%, 58.5%, and 0%, respectively. Similarly, graft survival at 1, 5, and 10 years in KT group was 98.7%, 90.2%, and 90.2%, respectively. Multivariate analysis showed body mass index (BMI) (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.82-0.93, p < 0.001), and albumin (HR 0.55, 95% CI 0.37-0.80, p = 0.002) were significant predictors of survival. In the 1 st year, patient survival was better in PD than KT, but after adjustment for BMI and albumin, both short-term and long-term survival in elderly KT group was better than that of PD. Hence, elderly ESRD patients should not be barred from KT just because of age.