Octogenarians on dialysis; navigating survival amidst struggles

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.