Article Figures & Data
Figures
- Figure 1.
Flowsheet of all incident dialysis patients who were aged ≥70 yr and patients who opted for MCM, showing outcomes, exclusions and patients who were lost to follow-up.
- Figure 2.
Kaplan-Meier survival curves. (A) MCM versus all RRT (from day 0). (B) MCM versus all RRT (from day 90). (C) MCM versus RRT emergency referral subgroup versus RRT nonemergency referral subgroup (from day 0).
- Figure 3.
Median survival for MCM cohort and the hemodialysis-only subgroup in the RRT cohort. Data shown are how many days were spent hospital-free, compared with in-patient stays in hospital and outpatient hospital attendances for dialysis.
- Figure 4.
Literature survey: Summary graph of survival of elderly patients with ESRD in previous studies.
Tables
Characteristic RRT(n = 173) MCM(n = 29) P Age (yr) 0.000001 mean 76.4 81.6 median 75.0 83.0 Female (n [%]) 54 (31.2) 12 (41.4) NS Diabetes (n [%]) 51 (29.5) 4 (13.8) NS Hemoglobin (g/L; mean ± SD) 108 ± 15 109 ± 13 NS Albumin (g/L; mean ± SD) 34.4 ± 7 37.4 ± 15.9 NS Total cholesterol (mmol/L; mean ± SD) 4.5 ± 1.3 4.5 ± 1.0 NS CCI score (mean ± SD) 4.0 ± 1.6 3.7 ± 1.8 NS Age-adjusted CCI score (mean ± SD) 7.2 ± 1.6 7.4 ± 1.9 NS Ethnicity (n [%]) NS white 133 (76.9) 21 (72.4) blacka 18 (10.4) 5 (17.2) Asianb 15 (8.7) 3 (10.3) unknown 7 (4.0) 0 (0.0) eGFR at start of dialysis (ml/min per 1.73 m2; median) 10.8 NA Length of follow-up from onset of RRT or PDI (mo; median) 26.7 12.9 Predialysis care (n [%]) emergency referral 52 (30.1) 11 (37.9) NS nonemergency referral early referral (>120 d) 91 (52.6) 15 (51.7) NS late referral (<120 d) 30 (17.3) 3 (10.3) Dialysis modalities (n [%]) HD only 112 (64.7) NA HD then switched to PD 6 (3.5) NA HD then transplant 1 (0.6) NA PD only 42 (24.3) NA PD then switched to HD 12 (6.9) NA Parameter All RRT Nonemergency Referral RRT Subgroup with ≥14 d of Predialysis Nephrology Care Emergency Referral RRT Subgroup with ≤14 d of Predialysis Nephrology Care HD-Only Patients MCM Value % 95% CI or P versus MCM Value % 95% CI or P versus RRT Emergency Referral Value % 95% CI or P versus MCM Value % 95% CI n including first 90 d 173 121 52 112 29 n excluding first 90 d 148 112 36 26 Survival, mo including first 90 d (median) 37.8 0.003 41.5 <0.001 21.7 33.9 <0.001 13.9 excluding first 90 d (median) 41.9 <0.001 43.0 0.17 25.8 – – 14.8 Rate of hospitalization (days/pt/yr) including first 90 d (mean) 25 6.9 6.8 to 7.0 23 6.2 6.0 to 6.3 – 30 8.1 7.9 to 8.3 16 4.3 4.0 to 4.7 excluding first 90 d (mean) 24 6.5 6.4 to 6.6 22 6.0 5.9 to 6.2 – 27 7.4 7.2 to 7.6 15 4.2 3.8 to 4.5 For HD-only and MCM patients rate of institutionalization, including first 90 d (mean) – – – – – – – 173 47.5 4.7 to 4.8 16 4.3 4.0 to 4.7 Location of death, n (%) Hospital 70 70.0 <0.05 45 67.2 – – – – 9 36.0 Home or in Hospice 21 21.0 14 20.9 – – – – 10 40.0 Unknown 9 9.0 8 11.9 – – – – 6 24.0 Total deaths 100 67 25 OR of dying in hospital 4.15 1.7 to 10.2 – – – – RR for dying in hospital 1.94 1.2 to 3.4 – – – – Censored/lost to follow-up (n) 11 6.0 4 3.0 0 0.0 -
RR, relative risk.
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Is Maximum Conservative Management an Equivalent Treatment Option to Dialysis for Elderly Patients with Significant Comorbid Disease?
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Dialysis
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- Renal Replacement Therapy in the Elderly Population
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