Outcome of renal replacement therapy in the very elderly

Background. In a retrospective case-note and computer database analysis we assessed the outcome of very elderly patients (greater than or equal to 75 years old) with end-stage renal disease (ESRD) on renal replacement therapy (RRT). Methods. Fifty-eight individuals aged 75 or over (group 1) commenced RRT be tween 1 January 1991 and 31 December 1995. Comparisons were made with other patients commencing RRT who were divided into two groups: group 2 (201 ind ividuals 65-74 years old) and group 3 (379 patients <65 years old). All sub jects were followed up until the point of assessment (30 June 1998), the ti me of death, or withdrawal from dialysis. Survival rates in the three group s were compared using Kaplan-Meier method. The number of hospital admission s, length of in-patient stay, and complications rate on RRT were assessed f or group 1. Results. One-year survival rates in groups 1, 2 and 3 were 53.5, 72.6, and 90.6% respectively and the 5-year survival rates were 2.4, 18.8, and 61.4% respectively. The very elderly spent 20% of their time in hospital, 46% had two co-morbid factors at the outset, and 26% developed multiple complicati ons while on RRT. Withdrawal from dialysis remained the most common cause o f death in this group of individuals (38%), followed by cardiovascular caus es (24%) and infections (22%). Conclusion. Very elderly ESRD patients on RRT have a very poor outcome and, since they are the largest growing group of RRT patients, this has importa nt implications for future health policies.