Perspective - the issues surrounding ESKD and dialysis in the elderly and those with co-morbidities

There is a disproportionate increase in the number of elderly patients, many with multiple co-morbidities, commencing dialysis. Predictors of survival for elderly patients on dialysis include age, comorbidity score, malnutrition, poor functional status and late referral. Patients with high co morbidity scores may not gain a survival advantage with dialysis vs a non dialysis pathway. Late referral and lack of dialysis access are independent predictors of mortality in elderly patients commencing dialysis. Hospital free survival may be similar in dialysis and non-dialysis treated groups We have little data on those choosing not to start dialysis in terms of numbers, clinical course and survival. Most available data is not from an Australian or New Zealand source. The effects on quality of life of different management pathways on patients, carers and staff still need to be addressed.