MO827: Clinical Characterization of Older People on Chronic Hemodialysis Nephrocare-Chile 2020–2021
Authors: Gulppi America , San Martín Pamela , Machuca Eduardo , Eugenia Sanhueza María 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The Chilean population has experienced an accelerated demographic aging, expecting that by the year 2050, older people (60 years and over) [1] will reach 31.6% of the country's population [2]. In Chile, patients &gt;60 years old on dialysis represent 53.6% of the total population with renal replacement therapy [3]. The objective of this work was to study the population of older people cared for in the NephroCare-Chile centers.

METHOD
A retrospective descriptive study, where the demographic and clinical characteristics of patients aged 60 years and over with chronic kidney disease on hemodialysis were analyzed, during the period January 2020–November 2021 in NephroCare-Chile dialysis network, distributed in 64 clinics, with information registered in Clinical Database- EuCliD [4]. Descriptive, association and/or dependency analyzes, and survival analyzes were performed using the Kaplan–Meier method, all this with Stata software.

RESULTS
A total of 6010 patients aged 60 years and over were studied, representing 60.8% of the total population attended in NephroCare-Chile for the period under study, who presented an average age of admission to dialysis of 66.2 ± 8.9 years, 57.6% of whom were men. Of this group, 5.3% were older than or equal to 85 years, and their average age at admission to dialysis was 82.0 ± 4.7 years, with statistically significant differences compared with the younger group (65.3 ± 8.2 years old). Of the older people studied (60 and over years), 52.5% were diabetic, 68% were hypertensive, 18.5% had malnutrition and 27.7% were at risk of malnutrition. At the end of the study period, the active vascular accesses were the Arteriovenous Fistula (54.1%) and Tunnelized Catheter (38.6%). A total of 82.7% of the cases had Albuminemia ≥3.5 g/dL, 67.6% had Hemoglobin levels ≥10 g/dL. Urea clearance estimated by Kt/V Single Pool revealed that 54.8% achieved Kt/Vsp ≥ 1.4. At the end of the study, 24% of the patients seen were deceased, at an average age of 72.4 ± 7.5 years. Of the patients seen who were older than or equal to 85 years, 40.0% were diabetic compared with the younger group (53.2%) (P &lt; 0.05), 67.9% were hypertensive and 45.2% presented compromised nutritional status, the albumin level was &lt;4 g/dL in 67.8%. The most frequent active vascular accesses in this group were the Tunnelized Catheter and the Arteriovenous Fistula (50.9% and 45.0%, respectively). Patients older than 85 years had lower serum levels of iPTH, Albumin and phosphorus compared with the younger group (P &lt; 0.05). Mortality at the end of the study was 36.9% for the group older than 85 years, while for the younger group it was 23.5% (P &lt; 0.05). The median overall survival of the patients seen in the study period was 155 months, regardless of their age at admission to hemodialysis. For those patients who were admitted between the ages of 60 and 84, their median survival was 115 months, while those patients who were admitted after the age of 85 had a survival of 96 months, not finding significant differences in these last two groups (log-rank &gt;0.05).

CONCLUSION
Most of the patients older than 60 years on hemodialysis in NephroCare-Chile reach a survival of &gt;10 years, being similar to the data published in the international literature. Hemodialysis patients &gt;85 years present indicators of adequacy, nutrition and survival that justify their admission and permanence in it. Our results confirm that replacement therapy significantly prolongs life expectancy in older patients, including those who start their therapy aged 85 years or older [5].