Clinical outcomes, quality of life, and costs in the North Thames Dialysis Study of elderly people on dialysis: a prospective cohort study
Abstract
Background Evidence-based health policy is urgently needed to meet the increasing demand for health services among elderly people, particularly for expensive technologies such as renal-replacement therapy. Age has been used to ration dialysis, although not always explicitly, despite the lack of rigorous empirical evidence about how elderly people fare on dialysis. We undertook a comprehensive assessment of outcomes in patients 70 years or over.Methods We did a 12-month prospective cohort study of outcomes in 221 patients with end-stage renal failure aged 70 years or over recruited from four hospital-based renal units. We assessed 1-year survival in 125 incident patients (70-86 years) and disease burden (hospital admissions, quality of life, costs) in 174 prevalent patients (70-93 years).Findings 1-year survival rates were: 71% overall; 80%, 69%, and 54% in patients 70-74 years, 75-79 years, and 80 years and older, respectively (p=0.008); and 88%, 71%, and 64% in patients with no, one, or two or more comorbid conditions, respectively (p=0.056). Cox regression analyses showed that mortality was significantly associated with age 80 years and older (relative risk 2.79 [95% CI 1.28-6.93]) and peripheral vascular disease (2.83 [1.29-6.17]), but not with diabetes, ischaemic heart disease, cerebrovascular disease, chronic obstructive airways disease, sex, or treatment method. In terms of disease burden, hospital admissions represent a low proportion of costs and was not required by a third of patients, mental quality of life in elderly dialysis patients was similar to that of elderly people in the general population, and the average annual cost per patient of 20802 (US$31200) (68% dialysis treatment, 1% transport, 19% inpatient hospital admissions, 12% medications) was within the range of other life-extending interventions.Interpretation Our results suggest that age alone should not be used as a barrier to referral and treatment and emphasise the need to consider the benefits of dialysis in elderly people. Indicators of the ability to benefit from treatment, rather than chronological age, should be used to develop policies that ensure equal access to care for all.
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Similar findings have been seen in older patients living in the community.
“Similar findings have been noted in community-dwelling elderly patients [20].”
From Should there be an expanded role for palliative care in end-stage renal disease? (2010) · cites this paper as [20]
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Self-citation
- Authors
- Lamping, D. L., Constantinovici, N., Roderick, P., Normand, C., Henderson, L., Harris, S., Brown, E., Gruen, R., & Victor, C.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- The Royal Free Hospital (GB)
- University of Southampton (GB)
- Charing Cross Hospital (GB)
- St George's Hospital (GB)
- Corresponding author
- Lamping, Donna L
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2000-11
- Volume
- 356
- Issue
- 9241
- Pages
- 1543-1550
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2122886742
- Cited by
- 349
- References
- 27
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 6 · 2022: 7 · 2021: 4 · 2020: 8 · 2019: 7 · 2018: 12 · 2017: 8 · 2016: 20 · 2015: 16 · 2014: 32 · 2013: 32 · 2012: 24
- FWCI
- 5.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- elderly dialysis patients, end-stage renal disease, renal replacement therapy, survival, comorbidities, peripheral vascular disease, quality of life, hospitalization, health care costs, health policy, elderly health services, cost-effectiveness
- MeSH terms
- Aged, Aged, 80 and over, Female, Health Services for the Aged, Renal Dialysis, Hospitalization, Humans, Kidney Failure, Chronic, London, Male, Prospective Studies, Quality of Life, Social Class, Health Care Rationing, Comorbidity, Survival Rate, Multivariate Analysis, Treatment Outcome, Resource Allocation
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