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Renal replacement therapies in the elderly: renal transplantation and continuous ambulatory peritoneal dialysis
Renal Replacement Therapies in the Elderly: Renal Transplantation and Continuous Ambulatory Peritoneal Dialysis K.H. Choi, S.I. Kim, S.K. Shin, J.I. Moon, Y.S. Kim, H.Y. Lee, D.S. Han, and K. Park
T
HE CURRENT therapeutic modalities such as renal transplantation (RTX), continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis for the elderly end-stage renal disease (ESRD) patient have become a recognized reality in the last decade.1–3 It has been well known that the selection of the treatment modality is critical in elderly ESRD patients for their quality life and survival.1– 4 MATERIALS AND METHODS To compare the efficacy, clinical outcome, and safety between RTX and CAPD in the elderly, we performed retrospective age- and sex-matched group comparison studies in 133 (50 RTX and 83 CAPD) nondiabetic and 39 (21 RTX and 18 CAPD) diabetic patients 55 years of age or older. We compared patients’ demographic characteristics, underlying comorbid diseases, causes of death, creatinine clearance (CCr), duration of hospitalization, graft survival rate, and clinical parameters just prior to and 6 months after CAPD or RTX between two groups.
RESULTS
In nondiabetic elderly ESRD patients, mean ages of the patients were 58.2 ⫾ 2.8 and 58.4 ⫾ 4.2 years in the RTX and CAPD groups, respectively. There was no difference in biochemical parameters just prior to renal replacement therapy between the two groups. But 6 months after the therapy, the patients on renal transplantation showed marked improvement of their biochemical parameters compared to those of patients on CAPD (serum creatinine 1.7 ⫾ 0.8 vs 8.9 ⫾ 2.8 mg/dL, albumin 4.3 ⫾ 0.4 vs 3.6 ⫾ 0.5 g/dL, cholesterol 247.0 ⫾ 68.0 vs 202.9 ⫾ 45.2 mg/dL, and hematocrit 44.3 ⫾ 3.2 vs 25.3 ⫾ 4.3%). There were more deaths in patients on CAPD, and they were: cerebrovascular accidents (4 in RTX, 12 in CAPD), cardiovascular accidents (3 in RTX, 10 in CAPD), infection (3 in RTX, 3 in CAPD), and others (0 in RTX, 3 in CAPD). Five-year patient survival rates were 74.3% and 57.4% in RTX and CAPD, respectively, with statistical significance. In diabetic elderly patients, mean ages were 60.1 ⫾ 3.3 and 57.6 ⫾ 8.5 years in RTX and CAPD groups, respectively. There was no difference in biochemical parameters just prior to renal
0041-1345/00/$–see front matter PII S0041-1345(00)01361-0 1814
replacement therapy between two groups. But 6 months after the therapy, the patients on renal transplantation showed marked improvement of their biochemical parameters compared to those of patients on CAPD (serum creatinine 1.5 ⫾ 0.6 vs 8.8 ⫾ 2.5 mg/dL, albumin 4.3 ⫾ 0.4 vs 3.7 ⫾ 0.3 g/dL, cholesterol 237.8 ⫾ 48.1 vs 235.4 ⫾ 59.3 mg/dL, and hematocrit 42.4 ⫾ 3.5 vs 27.8 ⫾ 4.4%). There were seven and six patient deaths in patients on RTX and CAPD, respectively, and they were: cerebrovascular accidents (two in RTX, four in CAPD), cardiovascular accidents (one in RTX, zero in CAPD), infection (three in RTX, one in CAPD), and others (one in RTX, one in CAPD). Five-year patient survival rates were 64.7% and 56.8% in RTX and CAPD, respectively, with statistical significance. But the duration of hospital stay was higher in the RTX group than that of the CAPD group (4.6 ⫾ 1.0 vs 2.8 ⫾ 0.4 d/mo) during the study period. DISCUSSION
This data showed higher patient survival with good biochemical parameters and lower patient morbidity in the RTX group. RTX seems to be a better modality of treatment for ESRD in people age 55 or over, and old age should not be a major risk factor in considering if a patient is eligible for RTX. REFERENCES 1. Ismail N, Hakim RM, Oreopoulos DG, et al: Am J Kid Dis 22:7596, 1993 2. Baek MY, Kwon TH, Kim YL, et al: Adv Perit Dial 13:158, 1997 3. Vandelli L, Medici G, Perrone S, et al: Nephrol Dial Transplant 11(Suppl 9):89, 1996 4. Tesi RJ, Elkhammas EA, Davies EA, et al: Lancet 343:461, 1994 From the Departments of Internal Medicine (K.H.C., S.K.S., H.Y.L., D.S.H.) and Surgery (S.I.K., J.I.M., Y.S.K., K.P.), Yonsei University College of Medicine, Seoul, Korea. Address reprint requests to Soon I.I. Kim, MD, Department of Surgery, Yonsei University College of Medicine, CPO box 8044, Seoul, Korea.
© 2000 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010 Transplantation Proceedings, 32, 1814 (2000)
T
HE CURRENT therapeutic modalities such as renal transplantation (RTX), continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis for the elderly end-stage renal disease (ESRD) patient have become a recognized reality in the last decade.1–3 It has been well known that the selection of the treatment modality is critical in elderly ESRD patients for their quality life and survival.1– 4 MATERIALS AND METHODS To compare the efficacy, clinical outcome, and safety between RTX and CAPD in the elderly, we performed retrospective age- and sex-matched group comparison studies in 133 (50 RTX and 83 CAPD) nondiabetic and 39 (21 RTX and 18 CAPD) diabetic patients 55 years of age or older. We compared patients’ demographic characteristics, underlying comorbid diseases, causes of death, creatinine clearance (CCr), duration of hospitalization, graft survival rate, and clinical parameters just prior to and 6 months after CAPD or RTX between two groups.
RESULTS
In nondiabetic elderly ESRD patients, mean ages of the patients were 58.2 ⫾ 2.8 and 58.4 ⫾ 4.2 years in the RTX and CAPD groups, respectively. There was no difference in biochemical parameters just prior to renal replacement therapy between the two groups. But 6 months after the therapy, the patients on renal transplantation showed marked improvement of their biochemical parameters compared to those of patients on CAPD (serum creatinine 1.7 ⫾ 0.8 vs 8.9 ⫾ 2.8 mg/dL, albumin 4.3 ⫾ 0.4 vs 3.6 ⫾ 0.5 g/dL, cholesterol 247.0 ⫾ 68.0 vs 202.9 ⫾ 45.2 mg/dL, and hematocrit 44.3 ⫾ 3.2 vs 25.3 ⫾ 4.3%). There were more deaths in patients on CAPD, and they were: cerebrovascular accidents (4 in RTX, 12 in CAPD), cardiovascular accidents (3 in RTX, 10 in CAPD), infection (3 in RTX, 3 in CAPD), and others (0 in RTX, 3 in CAPD). Five-year patient survival rates were 74.3% and 57.4% in RTX and CAPD, respectively, with statistical significance. In diabetic elderly patients, mean ages were 60.1 ⫾ 3.3 and 57.6 ⫾ 8.5 years in RTX and CAPD groups, respectively. There was no difference in biochemical parameters just prior to renal
0041-1345/00/$–see front matter PII S0041-1345(00)01361-0 1814
replacement therapy between two groups. But 6 months after the therapy, the patients on renal transplantation showed marked improvement of their biochemical parameters compared to those of patients on CAPD (serum creatinine 1.5 ⫾ 0.6 vs 8.8 ⫾ 2.5 mg/dL, albumin 4.3 ⫾ 0.4 vs 3.7 ⫾ 0.3 g/dL, cholesterol 237.8 ⫾ 48.1 vs 235.4 ⫾ 59.3 mg/dL, and hematocrit 42.4 ⫾ 3.5 vs 27.8 ⫾ 4.4%). There were seven and six patient deaths in patients on RTX and CAPD, respectively, and they were: cerebrovascular accidents (two in RTX, four in CAPD), cardiovascular accidents (one in RTX, zero in CAPD), infection (three in RTX, one in CAPD), and others (one in RTX, one in CAPD). Five-year patient survival rates were 64.7% and 56.8% in RTX and CAPD, respectively, with statistical significance. But the duration of hospital stay was higher in the RTX group than that of the CAPD group (4.6 ⫾ 1.0 vs 2.8 ⫾ 0.4 d/mo) during the study period. DISCUSSION
This data showed higher patient survival with good biochemical parameters and lower patient morbidity in the RTX group. RTX seems to be a better modality of treatment for ESRD in people age 55 or over, and old age should not be a major risk factor in considering if a patient is eligible for RTX. REFERENCES 1. Ismail N, Hakim RM, Oreopoulos DG, et al: Am J Kid Dis 22:7596, 1993 2. Baek MY, Kwon TH, Kim YL, et al: Adv Perit Dial 13:158, 1997 3. Vandelli L, Medici G, Perrone S, et al: Nephrol Dial Transplant 11(Suppl 9):89, 1996 4. Tesi RJ, Elkhammas EA, Davies EA, et al: Lancet 343:461, 1994 From the Departments of Internal Medicine (K.H.C., S.K.S., H.Y.L., D.S.H.) and Surgery (S.I.K., J.I.M., Y.S.K., K.P.), Yonsei University College of Medicine, Seoul, Korea. Address reprint requests to Soon I.I. Kim, MD, Department of Surgery, Yonsei University College of Medicine, CPO box 8044, Seoul, Korea.
© 2000 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010 Transplantation Proceedings, 32, 1814 (2000)