Introduction: The world's population is ageing. Old age was previously viewed as a relative contraindication to offering renal replacement therapy (RRT). This reticence was driven by concerns that the very elderly do not survive long enough to benefit from RRT and previous studies have quoted high mortality rates. This study assesses survival in an octogenarian cohort commencing haemodialysis (HD) and looks at factors potentially associated with prolonged survival.
Methods: We retrospectively analysed 11 years of data (1st January 2000 – 31st December 2010) of octogenarians starting HD at a teaching hospital in the West Midlands. Patients aged 80 years or older at the time of commencing HD were included in the analysis. Patients were excluded if they were already established on HD at another centre. Data was obtained from the hospital's renal database. Data collected included patient demographics, aetiology of renal failure, duration of HD, access type at first dialysis, Charlson comorbidity index score, cause of death and indication for HD.
Results: Data from 139 eligible patients were included for analysis (85 men, 54 women. Mean age 83.6 ± 2.8 years). This group accounted for 10.9% of new HD starters during this time period. Forty-two patients died within 90 days of starting dialysis (42/139, 30.2%). For those individuals who survived >90 days, mean (median) duration of HD is 871.8 (805) days. Long-term survival was more common in females and those whose first dialysis used an arteriovenous fistula.
Conclusions: This study demonstrates that there is a significant early mortality risk in octogenarians commencing HD. The majority of early deaths were caused by cardiac arrest and treatment withdrawal. Patients who survive beyond the initial 90 days, the majority have a good long-term survival. Long-term survival was more common in female patients and those who start HD with a fistula. Further study is needed to identify factors can reliably predict long-term survival.