Clinical outcomes, quality of life, and costs in the North Thames DialysisStudy of elderly people on dialysis: a prospective cohort study

Background Evidence-based health policy is urgently needed to meet the incr easing demand for health services among elderly people, particularly for ex pensive technologies such as renal-replacement therapy. Age has been used t o ration dialysis, although not always explicitly, despite the lack of rigo rous empirical evidence about how elderly people fare on dialysis. We under took a comprehensive assessment of outcomes in patients 70 years or over. Methods We did a 12-month prospective cohort study of outcomes in 221 patie nts with end-stage renal failure aged 70 years or over recruited from four hospital-based renal units, We assessed 1-year survival in 125 incident pat ients (70-86 years) and disease burden (hospital admissions, quality of lif e, costs) in 174 prevalent patients (70-93 years). Findings 1-year survival rates were: 71% overall; 80%, 69%, and 54% in pati ents 70-74 years, 75-79 years, and 80 years and older, respectively (p=0008 ); and 88%, 71%, and 64% in patients with no, one, or two or more comorbid conditions, respectively (p=0056), Cox regression analyses showed that mort ality was significantly associated with age 80 years and older (relative ri sk 2.79 [95% CI 1.28-6.93]) and peripheral vascular disease (2.83 [1.29-6.1 7]), but not with diabetes, ischaemic heart disease, cerebrovascular diseas e, chronic obstructive airways disease, sex, or treatment method. In terms of disease burden, hospital admissions represent a low proportion of costs and was not required by a third of patients, mental quality of life in elde rly dialysis patients was similar to that of elderly people in the general population, and the average annual cost per patient of pound 20 802 (US$31 200) (68% dialysis treatment, 1% transport, 19% inpatient hospital admissio ns, 12% medications) was within the range of other life-extending intervent ions. Interpretation Our results suggest that age alone should not be used as a b arrier to referral and treatment and emphasise the need to consider the ben efits of dialysis in elderly people. Indicators of the ability to benefit f rom treatment, rather than chronological age, should be used to develop pol icies that ensure equal access to care for all.