Early Mortality after the Initiation of Hemodialysis in Elderly Patients

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Background: The early mortality rate is high in elderly patients after hemodialysis initiation, and conservative kidney management (CKM) is introduced as an alternative to renal replacement therapy. Thus, we examined the prognosis of elderly dialysis patients at the Blood Purification Center of Dokkyo Medical University Hospital.

Methods: Among 378 hemodialysis-introduced patients at our hospital from November 2018 to December 2021, we examined the short-term mortality rate in 79 elderly patients of ≥ 80 years of age and analyzed the risk factors from the data at hemodialysis initiation compared to the 298 patients of < 80 years of age.

Results: For dialysis patients of ≥ 80 years of age, the mortality rate was 13% within 3 months (6% under 80), 23% (8%) within 6 months, and 28% (10%) within 12 months. Mortality after 12 months was further increased by up to 40% in patients of ≥ 90 years of age. Data at the time of the initiation of dialysis showed the risk of short-term death in elderly patients with low blood pressure, low body weight, and high hematocrit and potassium levels, and formula to predict the risk of death was proposed with a receiver operating characteristics (ROC) curve area under curve (AUC) of 0.8124.

Conclusion: The early mortality rate within 1 year after the initiation of hemodialysis was high in elderly patients. CKM could be an option in the high-risk patients with declining body weight and albumin levels, and elevated serum potassium and hematocrit.