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J Nephropathol. 2025;14(1): e21476.
doi: 10.34172/jnp.2024.21476
  Abstract View: 18
  PDF Download: 8

Original Article

Octogenarians on dialysis; navigating survival amidst struggles

Jhalak Agrohi ORCID logo, Saksham Kohli ORCID logo, Srinivas Vinayak Shenoy* ORCID logo, Daksh Agrohi, Shankar Prasad Nagaraju ORCID logo, Attur Ravindra Prabhu ORCID logo, Dharshan Rangaswamy ORCID logo, Indu Ramachandra Rao ORCID logo, Mohan Varadanayakanahalli Bhojaraja ORCID logo

1 Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
*Corresponding Author: Srinivas Vinayak Shenoy, Email: shenoy.srinivas@manipal.edu, Email: drsrinivasshenoy@gmail.com

Abstract

Introduction: The escalating longevity facilitated by medical advancements has led to a surge in elderly individuals grappling with chronic kidney disease (CKD) and progressing to end-stage renal disease (ESRD).

Objectives: Our study addresses the paucity of research on octogenarians undergoing dialysis, a highly co-morbid and frail subset, particularly in the context of a resource-limited setting like India.

Patients and Methods: A retrospective observational study at Kasturba Medical College and Hospital in Manipal, India, examined 18 octogenarian dialysis patients from 2017 to 2022. Clinical details, including age, co-morbidities, dialysis patterns, and laboratory data, were collected. The Cox-proportional hazards model assessed factors influencing survival.

Results: The majority-initiated dialysis in emergencies (72%), predominantly via central venous catheters. Hospitalizations post-dialysis were common (median 2.5). Survival rates at 1, 3, and 5 years were 61%, 54%, and 44%, respectively. Sudden cardiac death (64%) emerged as the predominant cause, with a significant impact of a higher Charlson comorbidity index on survival (HR 3.11; 95% CI [1.21-7.89]; P = 0.018).

Conclusion: Octogenarian dialysis patients, marked by substantial co-morbidities, exhibit reduced survival, particularly with higher comorbidity scores. Hospitalizations contribute significantly to morbidity. Our study underscores the need for nuanced care strategies tailored to this vulnerable population.


Implication for health policy/practice/research/medical education:

Dialysis in the very elderly, especially octogenarian patients, needs careful consideration of their co-morbidities before initiating dialysis. This study highlights the clinical profile of octogenarian patients on dialysis and gives insights into the vascular access characteristics, hospitalization, and factors associated with poor survival. This knowledge may be beneficial in decision-making around dialysis for elderly end-stage kidney disease patients.

Please cite this paper as: Agrohi J, Kohli S, Vinayak Shenoy S, Agrohi D, Prasad Nagaraju S, Ravindra Prabhu A, Rangaswamy D, Ramachandra Rao I, Varadanayakanahalli Bhojaraja M. Octogenarians on dialysis; navigating survival amidst struggles. J Nephropathol. 2025;14(1):e21476. DOI: 10.34172/jnp.2024.21476.

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Submitted: 14 Jun 2023
Accepted: 16 Mar 2024
ePublished: 17 Oct 2024
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