DEATH IN CONDITIONS OF CACHEXIA - THE PRICE FOR THE DIALYSIS TREATMENT OF THE ELDERLY

Death in conditions of cachexia is increasing in potential dialysis pa tients, as treated cohorts are aging, the mean age of new patients inc reased and access to treatment is unlimited. The present study analyze s the clinical features of 417 deaths in conditions of cachexia record ed in 1981 to 1990 in the Dialysis and Transplantation Registry of a n orthern Italian region, Piedmont (about 4,400,000 inhabitants, 20 dial ysis centers; 4,734 patients on file at December 31, 1990; yearly info rmation on 100% of the cases). Death in conditions of cachexia increas ed from 105 cases in the first four years taken into account (1981 to 1984), to 107 in the last two years (1989 to 1990). Prevalence is high er in the elderly (85% of the death over age 60). Most patients (90.5% ) were at high clinical risk. To assess whether the frequency of this diagnosis reflected the wide acceptance of elderly patients for dialys is and was a marked of vascular disease, a specific inquiry was conduc ted about 107 cachectic deaths recorded from 1989 to 1990: 82.5% of th e patients had diffused vascular disease, 11.5% were already cachectic when dialysis was initiated, and 66% were in cachexia at least six mo nths before death. Since mean age of patients dying in condition of ca chexia increased from 68.8 in the period of 1981 to 1984 to 70.3 years in 1989 to 1990, and mean time on dialysis from 2.8 years in 1981 to 1984 to 70.3 years in 1989 to 1990, the higher prevalence is not likel y to be due to lack of care of elderly patients. This is in keeping wi th this assumption that only 1.9% of the 107 patients that died in 198 9 to 1990 were on acetate dialysis at death 117% on hemo (dia) filtrat ion, 17.9% on CAPD and 51.9% on bicarbonate dialysis]. In conclusion, death in conditions of cachexia is a growing problem; its strict relat ionship with diffuse vascular disease justifies the definition of vasc ular cachexia. Prevalence of this umbrella diagnosis is increasing, de spite improving care of elderly and high risk patients and wider use o f high-tolerance dialysis treatments.