Factors influencing survival in hemodialysis patients aged older than 75 years: 2.5-year outcome study

The incidence of malnutrition is widely held to be greater in the elderly, but this specific factor has not been extensively studied in elderly dialys is patients. In a 30-month follow-up prospective study, we evaluated the ro le of nutrition on the outcome of 290 stable hemodialysis (HD) outpatients aged older than 75 years followed up in 20 French HD centers (167 men, 123 women; age, 79.8 +/- 4.2 years; previous time on dialysis, 41 +/- 38 months ). On the same day in January 1996, predialysis and postdialysis blood samp les were collected according to recommended procedures for dialysis quantif ication. Normalized protein catabolic rate, dialysis adequacy parameters, a nd estimation of lean body mass (LBM; expressed as observed/expected LBM va lues [obs/exp LBM]) were computed from predialysis and postdialysis urea an d creatinine levels. Overall survival rates were 80% and 65% after 1 and 2 years of follow-up, respectively, and were significantly less in patients w ith the lower quartile of obs/exp LBM. In univariate analysis using the Cox proportional hazards model, survival was significantly influenced by age, albumin level, prealbumin level, body mass index, and diabetes, but not by sex, Kt/V, duration of dialysis, cholesterol level, hemoglobin level, or ob s/exp LBM. In multivariate analysis, no variable remained significant. Card iovascular mortality accounted for 52.1% of the patient deaths. We conclude that in elderly HD patients, malnutrition influences overall survival desp ite adequate dialysis treatment. (C) 2001 by the National Kidney Foundation , Inc.