Elderly Peritoneal Dialysis Compared with Elderly Hemodialysis Patients and Younger Peritoneal Dialysis Patients: Competing Risk Analysis of a Korean Prospective Cohort Study

Abstract

The outcomes of peritoneal dialysis (PD) in elderly patients have not been thoroughly investigated. We aimed to investigate the clinical outcomes and risk factors associated with PD in elderly patients. We conducted a prospective observational nationwide adult end-stage renal disease (ESRD) cohort study in Korea from August 2008 to March 2013. Among incident patients (n = 830), patient and technical survival rate, quality of life, and Beck's Depression Inventory (BDI) scores of elderly PD patients (≥65 years, n = 95) were compared with those of PD patients aged ≤49 years (n = 205) and 50~64 years (n = 192); and elderly hemodialysis (HD) patients (n = 315). The patient death and technical failure were analyzed by cumulative incidence function. Competing risk regressions were used to assess the risk factors for survival. The patient survival rate of elderly PD patients was inferior to that of younger PD patients (P<0.001). However, the technical survival rate was similar (P = 0.097). Compared with elderly HD patients, the patient survival rate did not differ according to dialysis modality (P = 0.987). Elderly PD patients showed significant improvement in the BDI scores, as compared with the PD patients aged ≤49 years (P = 0.003). Low albumin, diabetes and low residual renal function were significant risk factors for the PD patient survival; and peritonitis was a significant risk factor for technical survival. Furthermore, low albumin and hospitalization were significant risk factors of patient survival among the elderly. The overall outcomes were similar between elderly PD and HD patients. PD showed the benefit in BDI and quality of life in the elderly. Additionally, the technical survival rate of elderly PD patients was similar to that of younger PD patients. Taken together, PD may be a comparable modality for elderly ESRD patients.

Fig 1. Study flow.

492 patients undergoing PD were enrolled and divided into 3 groups according to age (≤49 years, n = 205; 50~64 years, n = 192; ≥65 years, n = 95); 315 HD patients aged ≥65 years were enrolled for comparison with elderly PD patients.

Fig 2. Competing risk model for patient death and technical failure of elderly (≥65 years) patients undergoing peritoneal dialysis (PD), as compared with younger PD patients and elderly hemodialysis (HD) patients.

A. Comparison of patient death in younger (<65 years) patients undergoing PD. Transplantation and technical failure were considered competing risk events when examining patient death. B. Comparison of technical failure in younger (<65 years) patients undergoing PD. Patient death and transplantation were considered competing risk events when examining technical failure. C. Comparison of patient death in elderly patients undergoing HD. Transplantation was considered a competing risk event when examining patient death because there was no transplantation as a competing event in elderly patients.