Background: Reasons underlying dialysis decision-making in Octogenarians and Nonagenarians have not been\r\nfurther explored in prospective studies.\r\nMethods: This regional, multicentre, non-interventional and prospective study was aimed to describe characteristics and\r\nquality of life (QoL) of elderly (=80 years of age) with advanced chronic kidney disease (stage 3b-5 CKD) newly referred to\r\nnephrologists. Predictive factors of death and dialysis initiation were also assessed using competing-risk analyses.\r\nResults: All 155 included patients had an estimated glomerular filtration rate (eGFR) below 45 ml/min/1.73m2. Most\r\npatients had a non anaemic haemoglobin level (Hb) with no iron deficiency, and normal calcium and phosphate levels.\r\nThey were well-fed and had a normal cognitive function and a good QoL. The 3-year probabilities of death and dialysis\r\ninitiation reached 27% and 11%, respectively. The leading causes of death were cardiovascular (32%), cachexia (18%),\r\ncancer (9%), infection (3%), trauma (3%), dementia (3%), and unknown (32%). The reasons for dialysis initiation were\r\nbased on uncontrolled biological abnormalities, such as hyperkalemia or acidosis (71%), uncontrolled digestive disorders\r\n(35%), uncontrolled pulmonary or peripheral oedema (29%), and uncontrolled malnutrition (12%). No patients with acute\r\ncongestive heart failure or cancer initiated dialysis. Predictors of death found in both multivariate regression models\r\n(Cox and Fine & Gray) included acute congestive heart failure, age, any walking impairment and Hb <10 g/dL. Regarding\r\ndialysis initiation, eGFR <23 mL/min/1.73m2 was the only predictor found in the Cox multivariate regression model\r\nwhereas eGFR <23 mL/min/1.73m2 and diastolic blood pressure were both independently associated with dialysis\r\ninitiation in the Fine & Gray analysis. Such findings suggested that death and dialysis were independent events.\r\nConclusions: Octogenarians and Nonagenarians newly referred to nephrologists by general practitioners were highly\r\nselected patients, without any symptoms of the common geriatric syndrome. In this population, nephrologists� dialysis\r\ndecision was based exclusively on uremic criteria.
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