Transplantation versus haemodialysis in elderly patients. Renal Registry Committee.

ment therapy in Catalonia. In 1989, external validation Introduction documented that all variables were correctly reported thus showing that the data are valid to carry out clinical and Recently, inclusion of elderly patients in renal replaceepidemiological studies [5 ]. Since 1990, the Registry has been ment therapy programmes has increased in developed a regional outlet of the European Dialysis and Transplant countries [1–3]. In Catalonia there are no restrictions Association (EDTA). for patients entering renal replacement programmes Inclusion criteria for the patients assessed in the present study were: with respect to age or associated pathology. At the end of 1994, 4727 patients with chronic renal failure (1) beginning renal replacement therapy between 1984 and were on renal replacement therapy, i.e. a prevalence of 1993; 780.1 per million population (pmp). Of these patients (2) age at the start of the treatment between 55 and 70 years; 1605 (33.9%) were older than 64 years. In Catalonia (3) standard primary chronic renal disease, e.g. glomerular disease, interstitial disease, hereditary disease, congenital the proportion of patients above age 64 accepted for disease or disease of unknown origin [2 ]; renal replacement programmes increased from 20% to (4) inclusion in the renal transplant waiting list. 55.8% between the years 1984 and 1994. Patients in this age bracket actually represent 50% of patients According to the aim of the study, the patients were subdivided in two groups: treated by chronic haemodialysis. Renal transplantation in patients above age 55 years has also increased, (1) patients on haemodialysis (HD): patients who fulfilled from 8% in 1984 to 34.7% in 1995. In the same period the selection criteria and who had been treated with the mean age of patients receiving a renal transplant haemodialysis only; (2 ) patients who had received a transplant (Tx): patients increased from 37 years to 45 years. Transplant activity who fulfilled the selection criteria and who had received has increased markedly from 44 pmp in 1984 to a renal cadaveric transplant at any point in time. 55 pmp in 1994. However, the waiting list has not been reduced because the inclusion criteria for the For the study on associated morbidity, data available to the Registry were assessed concerning the following pathologwaiting list have been extended [4]. Increased renal ies: ischaemic heart disease, cardiomyopathy, arrhythmia, transplantation activity is basically the result of cerebrovascular accident, chronic obstructive pulmonary (i) better immunosuppressive therapy (cyclosporin A), disease, malignancies, diabetes mellitus, arthropathy, liver (ii ) reduction of the surgical risk and (iii) acceptance cirrhosis and other chronic liver diseases, and diseases of of donors of advanced age. the oesophagus, stomach, duodenum and intestine. It is the purpose of the present study to compare To measure rehabilitation, i.e. degree of functional autosurvival, associated morbidity and quality of life in nomy, the index of Karnofsky was used as modified for renal elderly patients treated by haemodialysis or renal patients by Gutman [6 ]. transplantation. The chi-square test was used to compare percentages and Student’s t-test to compare means. Survival analysis was carried out using the actuarial method. A proportional hazard model with Epilog program was applied using the Subjects and methods modification of Cox regression analysis proposed by Breslow. This permits measurement of univariate and multivariate The study was carried out using data of the RMRC (Renal coefficients with the aid of the iterative algorithm of Newton Patient Registry of Catalonia). This registry was founded by and Raphson. Relative risk estimates were determined with the autonomous government of Catalonia in 1984, as part the maximal likelihood method and the chi-square test. of the Programme Care for Renal Failure to provide a basis for planning of activities and distribution of resources. Reporting to the Registry is obligatory, i.e. the Registry Results receives information on all patients treated by renal replace-