Trends in clinical outcomes of older hemodialysis patients: data from the 2023 Korean Renal Data System (KORDS)

Abstract

With an increasing aging population, the mean age of patients with end-stage kidney disease (ESKD) is globally increasing. However, the current clinical status of elderly patients undergoing hemodialysis (HD) is rarely reported in Korea. The current study analyzed the clinical features and trends of older patients undergoing HD from the Korean Renal Data System (KORDS) database. The patients were divided into three groups according to age: <65 years (the young group), n = 50,591 (35.9%); 65-74 years (the younger-old group), n = 37,525 (26.6%); and ≥75 years (the older-old group), n = 52,856 (37.5%). The proportion of older-old group undergoing HD significantly increased in incidence and decreased in prevalence from 2013 to 2022. The median levels of hemoglobin, serum creatinine, albumin, calcium, phosphorus, and intact parathyroid hormone significantly decreased in the older-old group. The proportions of arteriovenous fistula creation and left forearm placement showed decreased trends with age. Although the utilization of low surface area dialyzers increased with age, the dialysis adequacy, including urea reduction ratio and Kt/V was within acceptable range in the older-old group on HD. Over the past 20 years, the mortality rate in the older-old group has increased, with cardiovascular diseases decreasing and infectious diseases increasing. The incidence of elderly patients undergoing HD has increased over time, but the high mortality of the older-old group needs to be solved. Therefore, it is imperative to develop holistic strategies based on age and individual needs for patients with ESKD.

Keywords: Elderly; End-stage kidney disease; Geriatrics; Hemodialysis; Mortality.

Figure 1.. Trends in incidence and prevalence, sex distribution, primary renal disease, and BMI according to age.

(A) Incidence trends of end-stage kidney disease (ESKD) according to age. (B) Prevalence trends of ESKD according to age. (C) Sex distribution according to age. (D) Distribution of primary renal disease according to age. (E) Distribution of BMI according to age. BMI, body mass index; CGN, chronic glomerulonephritis; DM, diabetes mellitus; HTN, hypertension.

Figure 2.. Laboratory values according to age.

(A) Median values of hemoglobin (Hb), serum creatinine (Cr), albumin (Alb), calcium (Ca), phosphorus (P), and intact PTH (iPTH) according to age. (B) Proportional chart representing the distribution of laboratory values within the reference range according to age.

Figure 3.. Types and locations of vascular access, dialysis adequacy, and nPCR according to age and sex.

(A) Distribution of types of vascular access according to age. (B) Location of arteriovenous fistula (AVF) according to age. (C) Distribution of dialyzer surface area according to age and sex. (D) Distribution of Kt/V according to age and sex. (E) Distribution of urea reduction ratio (URR) according to age and sex. (F) Distribution of nPCR according to age and sex. AVG, arteriovenous graft; nPCR, normalized protein catabolic rate.

Figure 4.. Complications, cause of death, and trends in mortality rates according to age stratified by sex and diabetes.

(A) Proportion of complications according to age. (B) Proportion of cause of death according to age. (C) Trends in mortality rates according to age. (D) Trends in mortality rates according to age stratified by sex. (E) Trends in mortality rates according to age stratified by diabetes. DM, diabetes mellitus.

Figure 5.. Comparison of survival rates according to age stratified by sex and diabetes.

(A) Survival rates according to age. (B) Survival rate according to age stratified by sex. (C) Survival rates according to age stratified by diabetes. DM, diabetes mellitus.