Survival and social inequality in older adults with stage 5 Chronic Kidney Disease undergoing hemodialysis treatment

Abstract

Introduction: The access of older adults to hemodialysis programs is increasingly common. The aim of this study was to determine the survival of older adults with Chronic Kidney Disease (CKD) stage 5 on Hemodialysis, after 5 years of follow-up, in relation to social inequality, and the clinical, biochemical and functional characteristics of the population. studied.

Methods: The present observational, analytical, retrospective study was carried out at the CLINEF Norte Nephrological Center, in Quito, Ecuador, in the period 2007-2012. Patients >64 years old, with CKD 5-d were included. Clinical, nutritional, economic, sociodemographic, mortality and overall survival (OS) variables were recorded. The sample was non-probabilistic. Survival was measured at 5 years with Kaplan-Meier and the association between the variables was analyzed.

Results: 71 cases are analyzed, with an age of 70.7 ± 6.6 years, 64.8% men, 49.3% with income < 530 dollars. The 5-year OS was 48.9%. The variables that were significantly associated with OS were: male sex (OS 49.0 ± 2.4 months, P=0.010), absence of CVD with OS 45.3 ± 2.4 months, P=0.010), albumin > 3.51 g/dl (OS 49.7 ± 2.9 months, P =0.009), Karnofsky > 80 ( OS 52.7 ± 2.2 months, P =0.002). Female sex and a history of CVD presented a statistically significant HR (HR 2.29, 95% CI 1.18 -4.43; HR 2.67, 95% CI 1.21-5.88). When adjusting for low income, together with female sex and low albumin, they maintained their association (HR 2.21, 95% CI 1.01-4.82), (P=0.044).

Conclusion: Nutritional status and functional assessment were the main factors associated with greater survival of older adults on hemodialysis. In a subanalysis it was shown that women with low economic income have lower survival.