Nephrol Dial Transplant (2001) 16: 128-133
© 2001 European Renal Association-European Dialysis and Transplant Association
Outcome of renal replacement therapy in the very elderly
1 Departments of Nephrology and 2 Medicine for the Elderly, Leicester General Hospital, Gwendolen Road, Leicester, and 3 Department of Epidemiology and Public Health, University of Leicester, Leicester, UK
Background. In a retrospective case-note and computer database analysis we assessed the outcome of very elderly patients (
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 between 1 January 1991 and 31 December 1995. Comparisons were made with other patients commencing RRT who were divided into two groups: group 2 (201 individuals 65–74 years old) and group 3 (379 patients <65 years old). All subjects were followed up until the point of assessment (30 June 1998), the time of death, or withdrawal from dialysis. Survival rates in the three groups were compared using Kaplan–Meier method. The number of hospital admissions, length of in-patient stay, and complications rate on RRT were assessed for 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 complications while on RRT. Withdrawal from dialysis remained the most common cause of death in this group of individuals (38%), followed by cardiovascular causes (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 important implications for future health policies.
Keywords: end-stage renal disease; outcome; renal replacement therapy; survival; very elderly
Correspondence and offprint requests to: Dr Sunil Kumar Munshi, Medicine for the Elderly, Glenfield General Hospital, Groby Road, Leicester LE3 9QP, UK.
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