Current characteristics of dialysis therapy in Korea: 2015 registry data focusing on elderly patients

Abstract

Because of increases in the elderly population and diabetic patients, the proportion of elderly among dialysis patients has rapidly increased during the last decades. The mortality and morbidity of these elderly dialysis patients are obviously much higher than those of young patients, but large analytic studies about elderly dialysis patients' characteristics have rarely been published. The registry committee of the Korean Society of Nephrology has collected data about dialysis therapy in Korea through an Internet online registry program and analyzed the characteristics. A survey on elderly dialysis patients showed that more than 50% of elderly (65 years and older) patients had diabetic nephropathy as the cause of end-stage renal disease, and approximately 21% of elderly dialysis patients had hypertensive nephrosclerosis. The proportion of elderly hemodialysis (HD) patients with native vessel arteriovenous fistula as vascular access for HD was lower than that of young (under 65 years) HD patients (69% vs. 80%). Although the vascular access was poor and small surface area dialyzers were used for the elderly HD patients, the dialysis adequacy data of elderly patients were better than those of young patients. The laboratory data of elderly dialysis patients were not very different from those of young patients, but poor nutrition factors were observed in the elderly dialysis patients. Although small surface area dialyzers were used for elderly HD patients, the urea reduction ratio and Kt/V were higher in elderly HD patients than in young patients.

Keywords: Dialysis adequacy; Elderly patient; Hemodialysis; Korea; Renal replacement therapy.

Figure 1

Dialysis prevalence and characteristics in Korea. (A) The number of patients with renal replacement therapy at the end of each year. (B) Proportion of renal replacement modalities, annual prevalence, and incidence. (C) The proportion changes of 3 major causes of ESRD. (D) Age distribution of dialysis patients according to underlying diseases. (E) Duration of maintenance HD and PD, and percent of estimated patient number according to the year. (F) Distribution of hemoglobin levels in HD and PD patients according to the year. CGN, chronic glomerulonephritis; DM, diabetic nephropathy; ESRD, end-stage renal disease; Hb, hemoglobin; Hct, hematocrit; HD, hemodialysis; HTN, hypertensive nephrosclerosis; KT, kidney transplantation; PD, peritoneal dialysis.

Figure 2

Dialysis characteristics. (A) Frequency of HD per week. (B) Distribution of URR of HD patients. Note the difference between males and females. (C) Dialysis adequacy parameters (nPCR and Kt/V) of HD patients. (D) Comparison of death causes, HD versus PD patients. (E) Patient survival rates according to underlying diseases (dialysis patients registered to Korean Society of Nephrology registry since 2001). (F) Annual number of KTs in Korea (including data from the Korean Network for Organ Sharing). *Surviving KT-waiting patient number at the end of each year. DM, diabetic nephropathy; ESRD, end-stage renal disease; F, female; GN, glomerulonephritis; HD, hemodialysis; HTN, hypertension; KT, kidney transplantation; M, male; Misc, miscellaneous; nPCR, normalized protein catabolic rate; PD, peritoneal dialysis; spKt/V, single-pool Kt/V; URR, urea reduction ratio.

Figure 3

Characteristics of elderly dialysis patients (I). (A) Elderly dialysis patients' (older than 65 years) proportion according to year. (B) Gender ratio of elderly dialysis patients compared with young patients. Young, < 65 years and elderly, ≥ 65 years. (C) Causes of ESRD. (D) Vascular access of elderly hemodialysis patients. (E) Blood pressure comparison between elderly and young dialysis patients. Note the wide pulse pressure of elderly dialysis patients. (F) Various laboratory data comparison between elderly and young dialysis patients. ABP, arterial blood pressure; AVF, arteriovenous fistula; AVG, arteriovenous graft; BP, blood pressure; CGN, chronic glomerulonephritis; DM, diabetic nephropathy; ESRD, end-stage renal disease; Hb, hemoglobin; HTN, hypertensive nephropathy; temp. cath, temporary catheter..

Figure 4

Characteristics of elderly dialysis patients (II). (A) Dialyzer surface area of elderly and young hemodialysis patients. (B) Hemodialysis adequacy comparison of elderly and young dialysis patients. (C) Complication prevalence rate comparison of elderly and young dialysis patients. (D) Rehabilitation status of elderly dialysis patients. ESRD, end-stage renal disease; nPCR, normalized protein catabolic rate; spKt/V, single-pool Kt/V; URR, urea reduction ratio.