Outcomes of predialysis nephrology care in elderly patients beginning to undergo dialysis

Seon Ha Baek, Shin Young Ahn, Sung Woo Lee, Youn Su Park, Sejoong Kim, Ki Young Na, Dong Wan Chae, Suhnggwon Kim, Ho Jun Chin

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22 Citations (Scopus)


Background: The proportion of elderly patients beginning to undergo dialysis is increasing globally. Whether early referral (ER) of elderly patients is associated with favorable outcomes remains under debate.We investigated the influence of referral timing on the mortality of elderly patients. Methods: We retrospectively assessed mortality in 820 patients aged ≥70 years with end-stage renal disease (ESRD) who initiated hemodialysis at a tertiary university hospital between 2000 and 2010. Mortality data was obtained from the time of dialysis initiation until December 2010. We assigned patients to one of two groups according to the time of their first encounters with nephrologists: ER (≥ 3 months) and late referral (LR; < 3 months). Results: During a mean follow-up period of 25.1 months, the ER group showed a 24% reduced risk of long-term mortality relative to the LR group (HR = 0.760, P = 0.009). Rate of reduction in 90-day mortality for ER patients was 58% (HR = 0.422, P=0.012). However, the statistical significance of the difference in mortality rates between ER and LR group was not observed across age groups after 90 days. Old age, LR, central venous catheter, high white blood cell count and corrected Ca level, and lower levels of albumin, creatinine, hemoglobin, and sodium were significantly associated with increased risk of mortality. Conclusions: Timely referral was also associated with reduced mortality in elderly ESRD patients who initiated hemodialysis. In particular, the initial 90-day mortality reduction in ER patients contributed to mortality differences during the follow-up period.

Original languageEnglish
Article numbere0128715
JournalPloS one
Issue number6
Publication statusPublished - 2015 Jun 1
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2015 Baek et al.

ASJC Scopus subject areas

  • General Biochemistry,Genetics and Molecular Biology
  • General Agricultural and Biological Sciences
  • General


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