RESULTS OF RENAL REPLACEMENT THERAPY IN ELDERLY PATIENTS

Objectives: Ageing of the general population and advances in hemodialy sis techniques have led to increasing acceptance of elderly patients f or renal replacement therapy. This poses a number of medical, ethical and socio-economic questions. We have studies aspects of hemodialysis in the elderly including quality of dialysis, survival and functional capacity to assess their suitability for this form of treatment. Patie nts and methods: We studied 160 patients on long term hemodialysis, of whom 53 (33%) were over 65 years old. The average follow-up was 27.9 +/- 17 months. We gathered information on dialysis dose, co-morbidity, measurements oi nutrition and biochemical control, functional capacit y and survival. Results: Actuarial survival of the elderly patients wa s 81.1% at one year and 39.6% at 5 years. Functionally, 24.5% can mana ge be themselves and a further 41.6% required only some change in life style or supervision. The elderly did not differ signiticantly from t hose under 65 in Kt/V, PCR or any of the following: comorbidity, body mass index, biochemical measurements such as serum total proteins, alb umin, prealbumin, cholesterol, triglycerides and blood lymphocytes. Ho wever age did correlate negatively with body fat, judged by triceps sk in fold thickness (r = -0.23, p < 0.01), muscle mass, judged by mid-ar m circumference (r = -0.21, p < 0.01) and plasma creatinine (r = -0.32 , p < 0.001), dietary intake of protein (r = -0.28, p < 0.01) and calo ries (r = -0.26, p < 0.01) judged by dietary survey. Conclusions: Elde rly patients received adequate dialysis and their initial co-morbidity was not greater than in younger patients. The nutritional state and f ood intake was deficient in the elderly and call from improvement. The functional capacity and survival rate obtained were considered reason able and support continued use of this treatment with current criteria for selection.