[Dialysis in the elderly. Indications for and efficacy of hemodialysis]

In Italy, as in all industrialized countries, life expectancy is raised during the past 100 years; this trend leads to important implications in medicine and among nephrologists. The increased number of end stage renal disease patients living beyond 65 years, who start dialysis, has modified the typical picture in dialysis centers. The causes of this phenomenon are different, including an increasing number of chronic diseases, typical of the "third age", like type II diabetes mellitus or vascular disease, creation of treatment facilities and success of prevention. Besides goods results obtained in elderly dialysis patients, mainly due to a better psychological reaction to the treatment and to an easy achievement of a high dialytic dose (Kt/V), there are some negative aspects, like the hemodynamic intolerance or the difficulties to make an ideal vascular access. However, these problems don't discourage the nephrologist but rather they must lead to achieve a personalized or alternative treatment. Even if the quality of life and rehabilitation are quite acceptable in many elderly patients, so to justify the wide acceptance criteria, many ethical and medical problems concern the most serious cases. Also in this condition, a wide acceptance criteria, followed by a possible withdrawal (time limited trial of treatment), can represent a reasonable solution.