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[Dialysis in the elderly].

S Alloatti1, M Manes, A M Gaiter

  • 1U.O. di Nefrologia e Dialisi dell Ospedale di Aosta, Aosta, Italy. nephroaosta@libero.it

Giornale Italiano Di Nefrologia : Organo Ufficiale Della Societa Italiana Di Nefrologia
|January 1, 2003
PubMed
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Elderly patients (>/= 75 years) show increasing dialysis incidence and prevalence, with vascular nephropathies and diabetes as primary causes. Cardiac issues dominate mortality, yet quality of life can be good.

Area of Science:

  • Nephrology
  • Geriatrics
  • Internal Medicine

Context:

  • The aging global population leads to a rising number of elderly individuals requiring renal replacement therapy.
  • Dialysis in patients aged 75 and older is a growing clinical challenge, with increasing incidence and prevalence.
  • Understanding the specific challenges and outcomes in this demographic is crucial for optimizing care.

Purpose:

  • To analyze the incidence, prevalence, causes, mortality, prognostic factors, and treatment outcomes of dialysis in elderly patients (>/= 75 years).
  • To identify critical aspects and potential improvements in managing dialysis for the elderly population.
  • To evaluate the impact of different dialysis modalities and patient-specific factors on survival and quality of life.

Summary:

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  • Elderly dialysis patients represent a significant and growing proportion of the dialysis population (20-33%), with an 8-16% annual growth rate.
  • Vascular nephropathies (13-50%) and diabetes (11-37%) are the leading causes of end-stage renal disease in this group.
  • First-year survival is 52-82%, declining to approximately 20% by year five, with cardiac disease being the primary cause of death (45%).
  • Prognostic factors include comorbidities and nutritional status; dialysis dose and duration are not linked to mortality.
  • Hemodialysis generally offers better survival, particularly for elderly diabetic patients, despite challenges like vascular access and intradialytic hypotension.

    • Impact:

    • Provides critical data for clinicians managing elderly dialysis patients, informing treatment decisions and resource allocation.
    • Highlights the importance of addressing comorbidities and nutritional status to improve outcomes in geriatric nephrology.
    • Suggests areas for further research, particularly in enhancing quality of life and managing specific complications in this vulnerable population.