Survival and factors predicting mortality in hemodialysis patients over 75 years old

Background: Patients starting dialysis treatments are in- creasingly elderly and with high morbidity and mortality. Survival and factors influencing mortality are discussed. Methods: We studied 2,601 patients who started hemo- dialysis in Andalucia (Spain) between 2004 and 2007. Of these, 71 patients died in the first 90 days of hemodi- alysis treatment and were excluded. Three groups were considered: group A, 694 patients aged less than 60 years; group B, 1,203 patients between 60 and 75 years; and group C, 704 patients aged over 75. Survival and factors associated with mortality were studied. Results: Mean survival was 46 months in group A, 41.6 in group B and 35 in the very elderly group. In univari- ate analysis using the Cox proportional hazards model, survival in the very elderly patients was significantly in- fluenced by low body mass index (BMI), venous cath- eter as initial vascular access, arterial hypertension, congestive heart failure (CHF), late referral to nephrolo- gist ( 10 mg/dL, serum albumin <3.5 g/dL, Kt/V (Daugirdas) <1.2 and time of dialysis session <180 minutes. In multivariate analysis, BMI, CHF, CRP, low serum albumin, Kt/V and time of dialysis session remained as independent pre- dictors of mortality. Conclusions: Survival of the very elderly patients who remained on hemodialysis more than 90 consecutive days was poor (about 3 years). Heart failure and mal- nutrition/inflammation are prognostic factors related to mortality in these patients on chronic hemodialysis.