A comparison of the effects of dialysis and renal transplantation on the survival of older uremic patients

Background. Patients over age 60 constitute half of all new patients accept ed into the renal replacement therapy programs in Australia. However, the o ptimal treatment of their end-stage renal disease remains controversial. Th e aim of the present study was to compare survival for dialysis and renal t ransplantation in older patients who were rigorously screened and considere d eligible for transplantation. Methods. The study cohort consisted of 174 consecutive patients over 60 who were accepted on to the Queensland cadaveric renal transplant waiting list between January 1, 1993 and December 31, 1997, Follow-up was terminated on October 1, 1998, Data were analyzed on an intention-to-transplant basis us ing a Cox regression model with time-varying explanatory variables. An alte rnative survival analysis was also performed, in which patients no longer c onsidered suitable for transplantation were censored at the time of their r emoval from the waiting list. Results. There were 67 patients receiving a renal transplant, whereas the o ther 107 continued to undergo dialysis, These two groups were well matched at baseline with respect to age, gender, body mass index, renal disease eti ology, comorbid illnesses, and dialysis duration and modality. The overall mortality rate was 0.096 per patient-year (0.131 for dialysis and 0.029 for transplant, P<0.001), Respective 1-, 3- and B-year survivals were 92%, 62% , and 27% for the dialysis group and 98%, 95%, and 90% (P<0.01) for the tra nsplant group. Patients in the transplant group had an adjusted hazard rati o 0.16 times that of the dialysis group (95% confidence interval 0.06 - 0.4 2), If patients were censored at the time of their withdrawal from the tran splant waiting list, the adjusted hazard ratio was 0.24 (95% confidence int erval 0.09 - 0.69), Conclusions. Renal transplantation seems to confer a substantial survival a dvantage over dialysis in patients with end-stage renal failure who are rig orously screened and considered suitable for renal transplantation.