Renal replacement therapies, especially hemodialysis (HD) in end-stage kidney disease, avoid an inevitable death caused by the disease. However, in elderly patients with multiple comorbidities, this therapy could derive a comparable survival than conservative management. Considering that hemodialysis represents a high cost for the health system, it is worth analyzing the effects of hemodialysis on survival.
The aim of the study was to analyze the survival and mortality of all national health security system’s patients (FONASA) admitted to hemodialysis in Chile from 2013 to 2019.
There were evaluated the influence of age when starting HD, sex, presence of hypertension, presence of diabetes mellitus (DM), the region of residence, and year of admission on mortality.
A total of 24,113 patients aged 61 ± 15 years (45% women) were analyzed. Forty five percent of patients were aged > 65 years. After 5 years of follow-up, the median survival in this age group was 36.1 months. Among patients who started hemodialysis at age > 85 years, the median survival was 14.8 months. Diabetic patients had a median survival of 52.3 months. Advanced age and DM were associated with higher annual mortality. Also, the region of residence and year of admission were associated with higher mortality at 3 and 12 months.
Conclusions: The survival of patients on hemodialysis is dependent on age and the presence of comorbidities, among other factors. We performed an analysis to determine if starting hemodialysis in older patients with comorbidities has a real benefit over conservative management in terms of survival.