Renal replacement therapy in the over-80s.
BACKGROUND
The incidence of chronic renal failure rises dramatically with age, which is no longer seen as a contraindication to treatment.


OBJECTIVE
To characterise Scottish dialysis patients aged 80 years and over at the time of their first treatment and to compare their outcomes with those of patients with other serious illnesses.


METHODS
Retrospective survey of all older patients starting dialysis in Dumfries and Galloway between 1 January 1994 and 31 December 2003, and of all older chronic renal failure patients starting dialysis in Scotland between 1 January 1994 and 31 December 2001. Comparison with 4,565 Scottish Lung Cancer and 14,398 myocardial infarction (MI) patients of similar age.


RESULTS
213/3,944 Scottish dialysis patients were aged 80 years or over at the time of their first treatment, representing 5.4% of all new patients and 9.2% of all new starts in 2001. Ninety per cent of older patients received haemodialysis as their first mode of renal replacement therapy. The most common diagnosis was chronic renal failure of unknown cause in 41% of cases. Quality of life, measured in a subset of Dumfries patients, suggested similar social functioning and mental health, but poorer physical health than their younger dialysis counterparts. Early mortality was high in all three diagnostic groups. Median survival from 90 days after the start of treatment, registration or hospital admission was 459 days (95% CI, 375, 543) for the older Scottish CRF patients, compared to 141 days (128, 154) for lung cancer and 1242 days (1192, 1292) for MI patients.


CONCLUSIONS
Dialysis can be an effective treatment modality for at least a proportion of octogenarians with end-stage renal failure.
Ronsberg
Fiona
F
Renal Unit, Dumfries and Galloway Royal Infirmary, Dumfries DG1 4AP, UK.
Isles
Chris
C
Simpson
Keith
K
Prescott
Gordon
G
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology; D008134:Long-Term Care / Q000523:psychology / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000401:mortality / Q000523:psychology; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000523:psychology; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology*; D006435:Renal Dialysis / Q000523:psychology / Q000706:statistics & numerical data; D017582:Renal Replacement Therapy / Q000523:psychology / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012606:Scotland; D015996:Survival Rate