#6279 ESKD TREATMENTS: A DIFFICULT CHOICE TO ELDERLY PATIENTS?
Authors: Mendes Beatriz , Inácio António , Fonseca Francisca , Piedade Ana , Domingues PatrÍcia , Farinha Ana 
Published: June 2023

Abstract

Background and Aims
End stage kidney disease (ESKD) treatment choice may be very difficult mainly for elderly patients. Dialysis can be burdensome for the frail patients, offering more aggressive procedures and less quality of life. Conservative Care (CC) may shorten life in a fit patient. This study aimed to describe our elderly patients' choices when it comes to CKD treatment options and reflect about them.

Method
We designed a single center retrospective observational, cross-sectional study regarding patients (pts) over 80 years old (yo) who attend the appointment of ESKD treatment modalities between July 2015 and and December 2021, since a Conservative Care Program is available in our hospital.

Results
During these 6,5 years, 113 pts over 80 yo were attended. Mean age was 85 yo (range 80–103). 66% were male and mean charlson comorbidity index (CMI) was 7 (sd ± 1,2). Mean seric creatinine was 3,69 mg/dl (sd 0,99; range 1,8-7,0). Mean estimated glomerular filtration rate was 17,41 (sd ±4,12) and 14,64 (sd ± 7,6) ml/min per 1.73 m2 when calculated with BIS1 and CKD-EPI equation, respectively. Two patients were already on a regular program of dialysis. Regarding CKD etiology, 31,9% was from multifactorial origin, 27,4% was from undetermined origin, 10,6% was hypertensive, 8% was diabetic, 6,2% was from chronic pyelonephritis and 9,7% was in the context of cardiorenal syndrome. Regarding treatment options, 54% chose hemodialysis, 38,9% chose conservative care (CC), 2,7% chose peritoneal dialysis and 2,7% refused any treatment. We also observed a significant increase in the CC during these 6.5 years of study. Of those who chose hemodialysis, 22,95% (n = 14) died before starting on a regular program of dialysis, 62,3% (n = 38) actually started on a regular program and 14,75% (n = 9) still maintain follow-up in nephrology appointment. Regarding those who died before starting on dialysis treatment, the mean time between choosing dialysis and death was 1,36 years (range 115 days to 5,46 years, median 1,36 years), and between starting on a regular program and death was 1,38 year (range 11 days to 4,9 years). The main cause of death was unknown (66%) (by lack of data), followed by infectious cause (26,6%). Considering those who chose CC, 31,8% (n = 14) died before starting the regular follow up, 54,5% (n = 24) are on a regular program of follow up, and 4,5% (n = 2) lately decided for dialysis. Regarding those who died before CC, the mean time between choosing it and death was approximately 1 year (range 29 days to 3,4 years), and between starting on a regular follow up and death was 0,68 years (range 14 days to 1,7 years). We didn’t find any statistical significance between CMI and the ESRD modality chosen (p = 0.709) or the occurrence of death (p = 0,496).

Conclusion
Even considering the poor prognosis and the high mortality rate, the majority of patients over 80 years old still chose dialysis over conservative kidney treatment. In our cohort, there was no survival benefit from those who choose dialysis instead of CC. CC should be offered as an alternative treatment to all the patients who may not benefit from dialysis. It is important to find tools who help us to guide patients in the best suitable choice in regard to ESKD treatments.