Peritoneal dialysis in patients 75 years of age and older--a 22-year experience

The role of peritoneal dialysis (PD) in the treatment of end-stage renal disease in elderly patients remains unclear. In the United States, PD is used only to a limited extent in that population. There are concerns about technique failure, including physical and psychosocial limitations and the risks of peritonitis. Thus, we retrospectively reviewed our 22 years of experience with patients 75 years of age and older who started on PD. Basic demographic data were collected, and mortality, technique failure, and peritonitis rates were determined. Quality of life (QOL) was assessed using the SF-36 questionnaire, a global QOL assessment, and a depression questionnaire. Among the 235 patients identified (mean age: 79 +/- 4 years; 51% white; 49% female; mean time on PD: 15.8 +/- 11.5 months), technique failure rates at 12 months were not significantly different for the patients 75 years of age older compared with the patients less than 75 years of age. Mortality rates were significantly higher in elderly patients. The peritonitis rate in patients 75 years of age and older was 1 episode in 23.6 patient-months compared with 1 episode in 23 patient-months in younger patients. The most common gram-positive organisms isolated were Staphylococcus epidermidis (38%0) and S. aureus (50%); gram-negative organisms accounted for 22%, and yeasts, 5% of peritonitis episodes. Reasons for transfer to hemodialysis included psychosocial problems (42%) and peritonitis (25%). Not surprisingly, physical component scores on the SF-36 were lower in the older than in the younger patients, but mental component scores on the SF-36 were slightly better in older than in younger patients, and global QOL and depression scores were not different between the groups. Our data suggest that PD is a reasonable modality for elderly patients.