Late referral and lack of dialysis access are independent predictors of mortality. Hospital free survival may be similar in dialysis and non-dialysis treated groups. Several studies have also identified comorbidity score[8, 10] as a strong predictor of mortality. Few studies BMN 673 concentration have examined factors associated with survival in patients treated on a non-dialysis pathway. One prospective observational study carried out by Wong et al. using the validated Stoke comorbidity score showed that comorbidity grading predicted survival in these
patients, with percentage survival at 1 year ranging from 83% in those with a grade zero score to 56% in those with a grade 2 comorbidity score. These data suggest that those with a low comorbidity score may have a reasonable survival on a non-dialysis pathway. Although these studies provide us with some information on factors predicting survival in elderly
patients with advanced CKD, there is a lack of prospective comparative studies looking to identify factors that might predict a survival benefit for dialysis versus non-dialysis care. There are however are a number of well-conducted observational studies that have attempted to overcome the bias of their retrospective nature, to compare the outcome Proteases inhibitor of dialysis versus non-dialysis care in this elderly cohort. Results of comparative studies suggest that survival advantage on dialysis in the very science elderly is lost when there is a high comorbidity score, particularly coronary disease, poor functional ability and high social dependence. The largest of these studies published by Chandna et al. from the UK, studied 844 patients over an 18-year period. They found that in patients over 75 years of age with high comorbidity, RRT was not associated with a significant increase in survival compared with those who were not dialysed. Similarly in another UK study, Murtagh et al. showed that although overall survival with dialysis was superior (84% vs. 68% 1-year survival), the survival benefit was lost in those with a high comorbidity score, with cardiovascular disease being the most predictive of poor outcome. By way of comparison,
the ANZDATA statistics show that a high proportion of elderly patients on dialysis in Australia have several factors predictive of a poor outcome on dialysis. Dialysis therapies in elderly ESKD patients are associated with decreased quality of life compared with the general population but it may be relatively preserved compared with younger dialysis patients. Dialysis therapies in the elderly are also associated with increased hospitalization and functional decline. Carers of elderly patients on dialysis show decreased quality of life and a substantial number also have signs of depression. We have little information about quality of life or functional decline with non-dialysis pathways and little information on the impact on carers in this group.