Factors Affecting Selection of a Dialysis Modality in Elderly Patients With Chronic Kidney Disease: A Prospective Cohort Study in Korea

Jang-Hee Cho; Jeong-Hoon Lim; Yeongwoo Park; Yena Jeon; Yon Su Kim; Shin-Wook Kang; Chul Woo Yang; Nam-Ho Kim; Hee-Yeon Jung; Ji-Young Choi; Sun-Hee Park; Chan-Duck Kim; Yong-Lim Kim

doi:10.3389/fmed.2022.919028

Factors Affecting Selection of a Dialysis Modality in Elderly Patients With Chronic Kidney Disease: A Prospective Cohort Study in Korea

Front Med (Lausanne). 2022 Sep 27:9:919028. doi: 10.3389/fmed.2022.919028. eCollection 2022.

Authors

Jang-Hee Cho^{1

2}, Jeong-Hoon Lim^{1

2}, Yeongwoo Park^{2

3}, Yena Jeon^{2

3}, Yon Su Kim^{2

4}, Shin-Wook Kang^{2

5}, Chul Woo Yang^{2

6}, Nam-Ho Kim^{2

7}, Hee-Yeon Jung^{1

2}, Ji-Young Choi^{1

2}, Sun-Hee Park^{1

2}, Chan-Duck Kim^{1

2}, Yong-Lim Kim^{1

2}

Affiliations

¹ Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
² Clinical Research Center for End Stage Renal Disease, Daegu, South Korea.
³ Department of Statistics, Kyungpook National University, Daegu, South Korea.
⁴ Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
⁵ Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
⁶ Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, South Korea.
⁷ Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea.

Abstract

Background: We investigated factors associated with the selection of a dialysis modality for elderly patients compared to younger patients.

Methods: This study included 2,514 incident dialysis patients from a Korean multicenter prospective cohort. Multivariate logistic regression analyses were performed with demographic, socioeconomic, and clinical data to analyze factors associated with the chosen dialysis modality. Differences in these factors were compared between the elderly (≥65 years) and younger (<65 years) patients.

Results: Of the enrolled patients, 1,746 (69.5%) and 768 (30.6%) selected hemodialysis (HD) and peritoneal dialysis (PD), respectively. The percentage of PD was higher in younger patients than in elderly patients (37.1 vs. 16.9%, p < 0.001). Multivariate analysis showed that planned dialysis (p < 0.001), employment status (p < 0.001), and independent economic status (p = 0.048) were independent factors for selecting PD, whereas peripheral vascular disease (p = 0.038) and tumor (p = 0.010) were factors for selecting HD in the younger group. In the elderly group, planned dialysis (p < 0.001) and congestive heart failure (CHF; p = 0.002) were associated with choosing PD; however, tumor (p = 0.006) was associated with choosing HD. A two-way ANOVA showed that planned dialysis and CHF showed a significant interaction effect with age on modality selection.

Conclusions: As the age of patients with chronic kidney disease increased, HD was more frequently selected compared to PD. Dialysis planning and CHF interacted with age in selecting dialysis modalities in elderly patients. Elderly patients were less affected by socioeconomic status than younger patients.

Keywords: aged; chronic kidney disease; dialysis (ESKD); hemodialysis (HD); peritoneal dialysis (PD).