Early dialysis initiation does not improve clinical outcomes in elderly end-stage renal disease patients: A multicenter prospective cohort study

Jae Yoon Park, Kyung Don Yoo, Yong Chul Kim, Dong Ki Kim, Kwon Wook Joo, Shin Wook Kang, Chul Woo Yang, Nam Ho Kim, Yong Lim Kim, Chun Soo Lim, Yon Su Kim, Jung Pyo Lee

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Abstract

Background: The optimal timing for initiating dialysis in end-stage renal disease (ESRD) is controversial, especially in the elderly. Methods: 665 patients ≥65 years old who began dialysis from August 2008 to February 2015 were prospectively enrolled in the Clinical Research Center for End-Stage Renal Disease cohort study. Participants were divided into 2 groups based on the median estimated glomerular filtration rate at the initiation of dialysis. Propensity score matching (PSM) was used to compare the overall survival rate, cardiovascular events, Kidney Disease Quality of Life Short Form 36 (KDQOL-36) results, Karnofsky performance scale values, Beck's depression inventory values, and subjective global assessments. Results: The mean patient age was 72.0 years, and 61.7% of the patients were male. Overall, the cumulative survival rates were lower in the early initiation group, although the difference was not significant after PSM. Additionally, the survival rates of the 2 groups did not differ after adjusting for age, sex, Charlson comorbidity index and hemoglobin, serum albumin, serum calcium and phosphorus levels. Although the early initiation group showed a lower physical component summary score on the KDQOL-36 3 months after dialysis, the difference in scores was not significant 12 months after dialysis. Furthermore, the difference was not significant after PSM. The Karnofsky performance scale, Beck's depression inventory, and subjective global assessments were not significantly different 3 and 12 months after dialysis initiation. Conclusions: The timing of dialysis initiation is not associated with clinical outcomes in elderly patients with ESRD.

Original languageEnglish
Article numbere0175830
JournalPloS one
Volume12
Issue number4
DOIs
Publication statusPublished - 2017 Apr

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All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Park, J. Y., Yoo, K. D., Kim, Y. C., Kim, D. K., Joo, K. W., Kang, S. W., Yang, C. W., Kim, N. H., Kim, Y. L., Lim, C. S., Kim, Y. S., & Lee, J. P. (2017). Early dialysis initiation does not improve clinical outcomes in elderly end-stage renal disease patients: A multicenter prospective cohort study. PloS one, 12(4), [e0175830]. https://doi.org/10.1371/journal.pone.0175830