DIALYSIS IN THE ELDERLY - IMPROVEMENT OF SURVIVAL RESULTS IN THE EIGHTIES

Analysis of long-term dialysis results is the cornerstone of renal rep lacement therapy evaluation. Elderly patients may be considered a cruc ial cohort, since subtle differences may be enhanced in a population o f lower life expectancy. The aim of the study was an analysis, from th e Piedmont Registry of Dialysis and Transplantation, of the results ob tained in 1981-1992 (northern Italy, about 4 400 000 inhabitants, 21 d ialysis centres, open acceptance since mid-1970s) in patients aged gre ater than or equal to 65 years (475 patients started treatment in 1981 -1985, 1026 in 1986-1992). As a first treatment, during the 12 years c onsidered acetate haemodialysis decreased sharply; bicarbonate haemodi alysis is currently the standard treatment (68%). Peritoneal dialysis is stable (21%), and haemodiafiltration is increasing (8%). Shifts bet ween treatments are frequent: 15% of elderly patients changed treatmen t at least once in 1991-1992. Nephroangiosclerosis/ischaemic renal dis ease, undefined causes and diabetes mellitus are the major causes of e nd-stage renal disease; 57.3% of patients have high risk conditions in addition to age. In this cohort of patients, mean age of new cases st arting dialysis significantly increased in 1986-1992 (72.7+/-5.4 years ) versus 1981-1985 (71.3+/-4.5 P<0.001). Despite this, survival at 2 y ears increased significantly from 54.6% in the period 1981-1985 to 59% in the period 1986-1992 (P<0.05). Even in an ageing dialysis populati on, therefore, choice of an open dialysis system with easy changes amo ng treatments allowed improvement of survival results; further technic al advances may help in maintaining present trends.