Long-term survival of older patients undergoing urgent-start peritoneal dialysis

Studies on long-term technique survival and mortality of urgent start of PD treatment in old adults especially age more than 80 years is lacking. This study design to investigate the long-term outcomes for older adults undergoing urgent-start peritoneal dialysis (USPD). Older patients who underwent USPD between January 1, 2007 and December 31, 2016, were included to estimate the factors that affect technique survival and mortality. All the patient were divided into two groups. An older patient group was defined as those aged ≥ 70 years but < 80 years, whereas a super-older patient group was defined as those aged ≥ 80 years. A total of 216 patients who underwent USPD with Mean age of (77.7 ± 5.0) years old and 46.8% male were included. The median follow-up time was 2.4 (1, 4.5) years. There was no significant difference in the risk of death-censored technical failure (log-rank test, P = 0.391) between the older (n = 152) and super-older (n = 64) patient groups. Prior referral to a renal clinic before USPD was the factor associated with better technical survival in all the older patients with USPD (hazards ratio HR = 0.131; 95% confidence interval CI, 0.045–0.376, P < 0.001). The mortality rate in the older patient group was significantly lower than that in the super-older patient group (log-rank test, p < 0.001). Regular renal clinic visits before USPD (adjusted HR = 0.482;95% CI, 0.329–0.706, P < 0.001), high body mass index (adjusted HR = 0.932, 95% CI, 0.883–0.983, P = 0.010), and serum albumin levels (adjusted HR = 0.947, 95% CI, 0.912–0.983, P = 0.004) were associated with lower mortality rates. Higher calcium level (adjusted HR = 3.237; 95% CI, 1.811–5.786, P < 0.001) was associated with high mortality in the patients. Older patients undergoing USPD may have more optimal PD outcomes. Improving predialysis management, as well as nutritional and calcium management, may be helpful in improving the long-term survival of older patients undergoing USPD.