Early initiation of peritoneal dialysis detrimental to elderly but not young patients
Starting elderly patients on peritoneal dialysis (PD) early, when estimated glomerular filtration rate (eGFR) is at ≥7.5 mL/min/1.73 m2, appears to do more harm than good, contributing to an increased risk of death, according to a study. Among younger patients, on the other hand, early commencement of PD neither improves clinical outcomes nor negatively influences survival.
The study included 2,133 patients receiving PD, of whom 1,803 were young (<65 years old; mean age, 42.6 years; 61.1 percent male) and 330 were elderly (≥65 years old; mean age, 71.2 years; 51.5 percent male).
Over a median follow-up of 43.6 months, 334 patients (18.5 percent) died, 288 (16.0 percent) were transferred to permanent hemodialysis (HD), and 494 (27.4 percent) received kidney transplantations in the young group.
The respective cumulative patient survival rates at years 1 and 5 were 98 percent and 77 percent in the early-start PD subgroup, 98 percent and 81 percent in the mid-start subgroup, and 98 percent and 82 percent in the late-start subgroup (p=0.008). The CV mortality rates at years 1 and 5 were 1 percent and 11 percent, 1 percent and 10 percent, and 1 percent and 10 percent in the early-, mid- and late-start PD subgroups, respectively (p=0.176).
In the elderly group, on the other hand, there were 222 (67.3 percent) deaths, 40 (12.1 percent) transfers to permanent HD, and three (0.9 percent) kidney transplantation recorded over a median follow-up of 37.2 months.
The respective cumulative patient survival rates at years 1 and 5 were 80 percent and 28 percent in the early-start PD subgroup, 82 percent and 32 percent in the mid-start subgroup, and 91 percent and 41 percent in the late-start subgroup (p=0.024). The CV mortality rates at years 1 and 5 were 3 percent and 56 percent, 11 percent and 47 percent, and 4 percent and 34 percent in the early-, mid- and late-start PD subgroups, respectively (p=0.176).
Multivariable Cox analysis showed no differences in the overall and CV mortality risks across the PD subgroups among young patients.
However, among elderly patients, early initiation of PD therapy conferred a risk increase for all-cause death (hazard ratio [HR], 1.54, 95 percent confidence interval [CI], 1.06–2.25) and CV death (HR, 2.07, 95 percent CI, 1.24–3.48) compared with late initiation. Overall or CV mortality was similar in the mid- and late-start subgroups.