#3435 UNPLANNED INITIATION OF HEMODIALYSIS IN ELDERLY PATIENTS WITH CHRONIC KIDNEY DISEASE: RISK FACTORS FOR SHORT TERM MORTALITY
Authors: Tagliente Federica , Panocchia Nicola , Caprio Francesca , Arnò Simone , Bonomini Mario , Grandaliano Giuseppe 
Published: June 2023

Abstract

Background and Aims
Although the initiation of unplanned dialysis in elderly patients is associated with a higher risk of death, overall this is still poorly understood and measured. The aim of the present study is to evaluate how “planned” or “unplanned” beginning of renal replacement therapy might influence the main clinical outcomes.

Method
We carried out an observational, retrospective, multicenter study on ESRD patients’ population who started planned or unplanned dialysis at the Policlinico “A. Gemelli” and the “SS. Annunziata” University Hospital of Chieti in the period from 1 January 2016 to 31 December 2020. All Patients in the unplanned population started emergency hemodialysis treatment during hospitalization. The primary outcome was all-cause mortality at three and six months. The main demographic, clinical features and the Couchoud Score, a prognostic score that stratifies elderly patients (age &gt; 75 years) with ESRD into groups with variable risk of short-term mortality after initiation of dialysis, of two group are shown in Table 1.

Results
During the whole study period, endend on 30 September 2022, 84 (68.3%) patients died in the unplanned group and 17 (24.6%) in the planned group. The unplanned group showed a higher Couchoud score (4.07 ± 2.63 vs 7.02 ± 3.05 p &lt; 0.001). In the unplanned group, 54.5% of patients died within 3 months and 58.5% within 6 months. In the Planned group, we observed only one death within 6 months. The mean survival of the unplanned group was 366 (± 544) days. In the unplanned group, 51 patients died during the hospital stay in which the hemodialysis treatment was started. The mean survival in these patients was 23 (± 71 SD) days. The difference in survival in the two cohorts of patients is shown in the Kaplan-Mayer analysis and is statistically significant (Logrank p &lt;0.001) (Figure 1). Interestingly, Couchoud Score (Spearman rho = -0.44; p &lt; .001) and unplanned treatment initiation (Spearman rho = -0.59; p &lt; .001), but not patients’ age (Spearman rho =-0.10; p = .168) presented a strong and inverse correlation with observed lifespan. The logistic regression model confirmed that Couchoud score was significantly and independently associate with mortality at three (p &lt;.001, 95%CI 0.16-0.49, McFadden R2 = 0.126) and six months (p &lt;.001, 95%CI 0.14-0.45, McFadden R2 = 0.105). In the subsequent logistic regression model, evaluating the individual variables contained in the Couchoud Score, only lack of autonomy was significantly associated with mortality both at three and six months (three months: OR 8.230, p &lt;.001, 95%CI 1.073-3.143; six months: OR 5.504, p = &lt;.001, 95%CI 0.726-2.685).

Conclusion
In elderly patients, unplanned dialysis is associated with a significant increase in in-hospital and at six-month mortality. In our study, the Couchoud Score represented an accurate and reliable short-term prognostic evaluation tool and may help nephrologist in the context of a shared decision-making process to select elderly patients more suitable for renal replacement therapy.