Article Text

other Versions

PDF
Original research
End-stage renal disease versus death in a Portuguese cohort of elderly patients: an approach using competing event analysis
  1. Josefina Santos1,2,
  2. Isabel Fonseca1,2,3,
  3. Jorge Malheiro1,2,
  4. Idalina Beirao1,2,
  5. Luisa Lobato1,2,
  6. Pedro Oliveira3,4,
  7. Antonio Cabrita1
  1. 1Nephrology Department, Hospital de Santo António, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal
  2. 2Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar Porto, Universidade do Porto, Porto, Portugal
  3. 3ISPUP5EPI Unit, Universidade do Porto, Porto, Portugal
  4. 4Department of Population Studies, Instituto de Ciências Biomédicas Abel Salazar Porto, Universidade do Porto, Porto, Portugal
  1. Correspondence to Josefina Santos, Nephrology Department, Hospital de Santo António, Centro Hospitalar e Universitário do Porto, Largo Prof. Abel Salazar, 40995001 Porto, Portugal; josefina.sts{at}gmail.com

Abstract

Chronic kidney disease (CKD) is higher in elderly, but mortality outweighs the risk of end-stage renal disease (ESRD). Our aim was to identify prognostic markers for ESRD or death in elderly CKD, within a competing-risk analysis. This is a longitudinal study of consecutive newly referred patients with CKD ages 65 years, followed until the time of the first event (ESRD or death), using a competing-risk analysis. A modified Charlson Comorbidity Index (mCCI) was subdivided into subgroups (0-2, 3-4, ≥5). Patients were followed for hospitalizations that occurred prior to the outcomes. Among 416 patients, age 76±8 years, 52% male, median estimated glomerular filtration rate of 32 mL/min per 1.73 m2, 50% had diabetes, and 67% cardiovascular disease. Over a median follow-up of 3.6 years, 36 patients progressed to ESRD (8.7%) and 103 died (24.8%). Older age (subdistribution HR (sHR)=1. 06; p<0.001), creatinine≥1.6 mg/dL (sHR=2.03, p=0.004), hemoglobin <11 g/dL (sHR=1.91, p=0.003), mCCI score≥5 (sHR=3.01, p<0.001) and having one or more hospitalizations (sHR=1.73, p<0.001) were associated with death before ESRD. The independent predictors for ESRD with competing risk of death were: lower age (sHR=0.94; p=0.009), creatinine≥1.6 mg/dL (sHR=3.26, p=0.006), hemoglobin <11 g/dL (sHR=2.15, p=0.027), peripheral vascular disease (sHR=3.45, p=0.001) and having one or more hospitalizations (sHR=1.56, p=0.031). Elderly referred patients with CKD are near threefold more likely to die than progress to ESRD. A competing-risk framework based on available clinical and laboratory data may discriminate between those outcomes and could be used as a decision-making tool.

  • Aging
  • Death
  • Renal Insufficiency
  • Chronic
  • Morbidity

Statistics from Altmetric.com

Footnotes

  • Contributors JS, IF and JM were involved in research design, writing and in data collection. IB, LL, PO and AC were involved in editing.

  • Competing interests None declared.

  • Ethics approval The study was performed in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Centro Hospitalar Universitário do Porto.

  • Provenance and peer review Not commissioned; externally peer reviewed.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.