Renal replacement therapy in the elderly: Medical, ethical, and psychosocial considerations

As patients over the age of 65 become the fastest growing segment of our tr eated end stage renal disease (ESRD) population, nephrologists and allied h ealthcare workers who care for these patients must become well versed in th e many issues specific to this group. Elderly patients contribute the great est fraction to the incidence and prevalence of the United States ESRD popu lation. Their life expectancy is greatly reduced compared with age-matched counterparts from the general population. Cardiac disease is the leading ca use of death. Although renal transplantation remains the most successful fo rm of renal replacement therapy, only a small fraction of elderly ESRD pati ents are transplanted. The renal research community has made great strides in improving patient outcomes on dialysis over the last decade in many area s; however, little attention has been focused on the elderly ESRD patient. The substantial mortality and comorbidity experienced by this population ma kes their management an ongoing challenge. Many unresolved issues remain fo r elderly ESRD patients in the timing of dialysis initiation, choice of dia lytic therapy, use of renal transplantation, and management of cardiovascul ar disease. It is anticipated that future research in these areas wilt iden tify optimal treatment strategies for elderly ESRD patients starting on dia lysis and improve patient outcomes. (C) 2000 by the National Kidney Foundat ion, Inc.