Dr Punit Yadav

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• Dr Punit Yadav
• Dr Jyoti Baharani

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(No Transcript)
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HD vs. non-dialytic management

• Is maximum conservative management an equivalent
  treatment option to dialysis for elderly patients
  with significant comorbid disease? CJAN, Carson
  et el
• Dialysis prolongs survival for elderly patients
  who have ESRD with significant co morbidity by
  approximately 2yr
• Choosing not to dialyse evaluation of planned
  non-dialytic management in a cohort of patients
  with end-stage renal failure, Smith et el
• In high-risk, highly dependent patients with
  renal failure, the decision to dialyse or not has
  little impact on survival
• Dialysis or not? A comparative survival study of
  patients over 75 years with chronic kidney
  disease stage 5, Murtagh et el
• Choosing dialysis rather than conservative
  management is associated with better survival in
  patients aged gt75 years with advanced CKD
• Conservatively managed patients with stage 5
  chronic kidney diseaseoutcomes from a single
  centre experience, Ellam et el
• Patients known to a nephrologist before reaching
  CKD 5 survived longer (median 32 months) than
  those presenting with CKD 5.

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Aims and Methods

• Describe patient characteristics associated
  co-morbidity at time of starting HD
• Outcome of octogenarians on HD programme in HEFT

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Methods

• Retrospective electronic record survey of all
  patients aged 80 years or above commencing
  haemodialysis for ESRF in a single centre from
  1992 to 2010 (18 years)

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• Data collected on
• patient demographics
• underlying cause of ESRF
• total duration on haemodialysis
• co-morbidity at time of commencing RRT (Charlson
  Index)
• outcome of patients at 12 months
• cause of death

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Results
N177, Mean age 83.4 yrs, MF ratio 1.51
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2 decades of data

• Mean age for commencing HD was no different pre
  or post 2001

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Number of pts known to Renal team prior to
commencing HD
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HD access on commencing RRT
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Aetiology of ESRD
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Adjusted Charlson score (med/high group)
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12 month mortality in high risk score group
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12 month mortality
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Cause of death
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Conclusion

• Number of elderly patients on HD has increased
  over time
• Most octogenarians on HD have significant
  co-morbidity
• Improved survival in spite of more sick patients
  being included in HD programme

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• Thank You