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Half Elderly Starting Dialysis After Age 75 Die Within Year Finds Mayo Clinic

New evidence to to help guide shared decision-making among the patient, family members and care team - see video

Bjorg ThorsteinsdottirNov. 8, 2013 - Half of elderly patients who start dialysis after age 75 will die within one year, according to new research from Mayo Clinic finds that. Although, age alone was not a good measure. The findings will being presented this week at the American Society of Nephrology's Kidney Week 2013 in Atlanta.

"Many elderly patients and their families feel that they have no choice but to start dialysis, with several expressing regret from having initiated therapy," says primary care physician Bjorg Thorsteinsdottir, M.D., lead study author and a health care delivery scholar with the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

Research from Mayo Clinic finds that half of elderly patients who start dialysis after age 75 will die within one year. Lead study author and a health care delivery scholar with the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Bjorg Thorsteinsdottir, M.D., reports.

"The goal of our study was to develop evidence about dialysis outcomes to help guide shared decision-making among the patient, family members and care team."

Researchers reviewed four years of medical records for 379 patients who were at least 75 years old when they began dialysis treatment at Mayo Clinic in Rochester.

The majority (76 percent) started dialysis while in the hospital for a chronic illness or sudden medical event such as pneumonia.

Mortality was very high, with 40 percent of patients dying within six months. The highest mortality rates were seen in patients who started dialysis in the intensive care unit. Only 27 percent were alive after six months.

Patients who started dialysis in the hospital often were not able to return home. Of the patients admitted to the hospital from home, 28 percent died while in the hospital or were discharged to hospice, 28 percent were discharged to a nursing home, and only 37 percent were able to return home to independent living.

The graph shows patients age 75 or older who start dialysis in the intensive care unit have significant risk of dying within one year of hospitalization. Groups starting in other settings fare better.

Age alone was not a good predictor of survival, and healthier elderly patients did better. Most deaths were preceded by a decision to withdraw life support, including dialysis.

"We hope that these study results will help inform the difficult decisions that patients and family members must make about whether or not to begin dialysis," says Dr. Thorsteinsdottir. "We want to make sure that the treatment is congruent with our patients' goals and values."

 

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About Mayo Clinic

Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit MayoClinic.com.

>> About dialysis

>> About Mayo Patient Care

>> American Society of Nephrology's Kidney Week 2013

 

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