Prognostic Analysis Of Aged End-stage Renal Disease Patients Receiving Hemodialysis And Peritoneal Dialysis

Objective:To know basic characteristics of elderly hemodialysis and peritoneal dialysis population in general hospital in china.Evaluating and comparing survival in patients on hemodialysis and peritoneal dialysis.And to explore the main risk factors affecting survival of dialysis.Methods:Patients aging>60 years old who initiated dialysis between January 1,2008 and December 31,2014 in our Hospital of Zhejiang University were included.Collect their demographic data and clinical data,then all patients were followed up through 30 September 2015.Propensity score method(PSM)was applied to adjust for selection bias.Kaplan-Meier method was used to obtain survival curves and a Cox regression model was used to evaluate risk factors for mortality.The method of intention to treat analysis and as treated analysis were both performed in this study.Results:1.447 eligible patients with maintenance dialysis were identified,236 with hemodialysis and 211 with peritoneal dialysis.174 pairs of patients were matched,with the baseline data[age,gender,Charlson comorbidity index(CCI),the primary disease,serum creatinine,plasma albumin and glomerular filtration rate]between two groups showing no significant difference(P>0.05).Cardiovascular events,cerebrovascular events and infection were major causes of death in both groups and there was no significant difference in the causes of death between two groups(P>0.05).2.Results of intention to treat analysis;The overall survival rates at 1 and 5 year were 93.6%and 63.4%respectively in HD group,91.9%and 61.5%in PD group.The differences of total survival rates between HD and PD patients were not significant(P>0.05).HD<80 years group survival rate was significantly higher than HD>80 years group(P=0.015);Survival rate of HD patients with diabetic nephropathy were significantly lower than HD patients with nondiabetic nephropathy(P=0.032);Survival rate of CCI<5 HD group was significantly higher than that of CCI>5 HD group at the beginning of dialysis(P=0.016);According to the above three layered found,the differences of survival rate between HD and PD patients were not signifcant(P>0.05),and comparison between PD in the way,there were no significant differences in the survival rate(P>0.05);The multivariate cox regression analysis showed age(≥80 year)(P<0.001,HR=1.058,95%CI 1.028-1.088),diabetic nephropathy(P=0.001,HR=2.161,95%CI 1.384-3.373),CCI>5(P=0.007,HR=1.935,95%CI 1.201-3.117)were independent prognostic risk predictors in HD patients;age(≥80 year)(P=0.022,HR=1.043,95%Cl 1.006-1.081),serum albumin level<35 g/L(P=0.025,HR=1.776,95%CI 1.075-2.934),and prealbumin(P=0.012,HR=0.968,95%CI 0.944-0.993)were independent prognostic predictors in PD patients.3.Results of as treated analysis was constant with those of intention to treat analysis.Conclusions:1.The differences of total survival rates between aged HD and PD patients are not significant.2.HD<80 years group survival rate was significantly higher than HD>80 years group;Survival rate of HD patients with diabetic nephropathy were significantly lower than HD patients with nondiabetic nephropathy;Survival rate of CCI<5 HD group was significantly higher than that of CCI>5 HD group at the beginning of dialysis.3.Age,diabetic nephropathy,CCI>5 and age,serum albumin<35 g/L,prealbumin>30 g/L respectively influence the survival of elderly HD and PD patients.