Chronic dialysis in patients over age 65

In the United States, persons over the age of 65 are expected soon to become the majority of those people who will require maintenance dialysis therapy. Many of these individuals have numerous comorbid medical complications, which, together with altered physiologic adaptation related to aging, create a great challenge for the nephrologist. Despite a considerably lower group survival rate and increased hospitalization utilization as compared with younger patients, many elderly dialysis patients tolerate therapy very well and appear quite satisfied with the quality of their lives. Both hemodialysis and peritoneal dialysis are suitable treatment modalities for elderly patients, but recommendations regarding type of dialysis must be individualized, taking both medical and psychosocial issues into consideration. Vascular access problems are particularly important for the elderly and contribute to significant morbidity. Malnutrition and cardiovascular complications also require special attention. Withdrawal from dialysis appears to be increasingly common among elderly ESRD patients and highlights the need for the completion of advance directives. A trial of dialysis may allow elderly patients and their families additional time to decide whether long-term dialysis is deemed appropriate.