Hemodialysis or Peritoneal Dialysis in the Very Elderly? Real-World Evidence from a Propensity-Matched Catalan Cohort

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Abstract Title *

Hemodialysis or Peritoneal Dialysis in the Very Elderly? Real-World Evidence from a Propensity-Matched Catalan Cohort

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Co-author 1

Nestor Toapanta nestor.toapanta@vallhebron.cat Vall d'Hebron Hospital Nephrology Barcelona Spain -

Co-author 2

Jordi Comas jcomas@catsalut.cat Catalan Transplantation Organization Catalan Transplantation Organization Barcelona Spain -

Co-author 3

Maria Azancot mariaantonieta.azancot@vallhebron.cat Vall d'Hebron Hospital Nephrology Barcelona Spain -

Co-author 4

Natalia Ramos natalia.ramos@vallhebron.cat Vall d'Hebron Hospital Nephrology Barcelona Spain -

Co-author 5

Juan Carlos Leon Roman juancarlos.leon@vallhebron.cat Vall d'Hebron Hospital Nephrology Barcelona Spain -

Co-author 6

Sara Nuñez sara.nunez@vallhebron.cat Vall d'Hebron Hospital Nephrology Barcelona Spain -

Co-author 7

Hector Bedoya hectorluis.bedoya@vallhebron.cat Vall d'Hebron Hospital Nephrology Barcelona Spain -

Co-author 8

Efrain Tatis efraintatis@gmail.com Vall d'Hebron Hospital Nephrology Barcelona Spain -

Co-author 9

Natalia Padron natalia.padron@vallhebron.cat Vall d'Hebron Hospital Nephrology Barcelona Spain -

Co-author 10

Jaume Tort jtort@catsalut.cat Catalan Transplantation Organization Catalan Transplantation Organization Barcelona Spain -

Co-author 11

Francesc Moreso francescjosep.moreso@vallhebron.cat Vall d'Hebron Hospital Nephrology Barcelona Spain -

Co-author 12

Maria Jose Soler Romeo mariajose.soler@vallhebron.cat Vall d'Hebron Hospital Nephrology Barcelona Spain *

Co-author 13

Co-author 14

Co-author 15

Introduction

The number of octogenarians starting renal replacement therapy (RRT) continues to rise worldwide, driven by population aging and improved chronic disease management. Modality choice in this population is challenging due to frailty and multimorbidity. Peritoneal dialysis (PD) may offer hemodynamic stability and autonomy but can be difficult to sustain long term.

Methods

A propensity score–matched analysis was performed using data from the Catalan Renal Registry. Patients aged ≥80 years initiating RRT with hemodialysis (HD) or PD were included. Analyses were adjusted for age, sex, comorbidity, and period of dialysis initiation (2000–2007, 2008–2014, 2015–2021). Survival was compared using Cox proportional hazards models and Kaplan–Meier curves, considering patients who transitioned from PD to HD (PD→HD) as a separate group.

Results

After matching, no statistically significant differences in five-year survival were observed among HD, PD, and PD→HD groups. Transition from PD to HD was independently associated with higher mortality (HR 1.47; 95% CI: 1.08–2.00), while patients remaining on PD showed a non-significant trend toward increased mortality (HR 1.23; p=0.055). Older age and initiating RRT in 2000–2007 were independently associated with worse outcomes.

Conclusion

Among patients aged ≥80 years initiating dialysis, five-year survival was comparable across modalities. Transition from PD to HD likely represents rescue therapy rather than a survival advantage. These findings emphasize the need for individualized modality selection and close follow-up of elderly patients managed with PD.

Kewords