title: Clinical practices and outcomes in elderly hemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS).
abstract: OBJECTIVE
  Demand for hemodialysis among elderly patients is increasing worldwide. Although clinical care of this high-risk group is complex and challenging, no guidelines exist to inform hemodialysis practices. The Dialysis Outcomes and Practice Patterns Study (DOPPS) provides a unique opportunity to assess dialysis practices and associated outcomes among elderly versus younger patients on chronic in-center hemodialysis in 12 countries.
  
  
  METHODS
  Clinical characteristics, dialysis practices, and outcomes of elderly versus younger patients were compared among participants in four DOPPS regions in 2005 through 2007.
  
  
  RESULTS
  Although participant mean age increased over time in all DOPPS countries, the percentage of elderly varied widely. Overall, comorbidities and malnutrition were more common in the elderly. Fistulae were used less frequently among elderly versus younger patients in Europe and North America but not in Australia, New Zealand, and Japan. No difference in treatment time was observed between elderly and younger patients after normalizing for body weight. In all regions, ultrafiltration rates were lower among elderly patients. Elderly patients reported poorer quality of life with respect to the physical but not mental component scores. Mortality risk was three- to sixfold higher in the elderly group, whereas causes of death overall were similar for elderly and younger patients.
  
  
  CONCLUSIONS
  Elderly patients represent a different proportion of DOPPS participants across countries, possibly reflecting differences in policies and clinical practices. In general, hemodialysis practices in the elderly reflected each region's clinical patterns, with some variation by age group depending upon the practice.
authors: Lapeyronie University Hospital, CHU Montpellier University, Montpellier, France. b-canaud@chu-montpellier.fr
authors: Bernard
authors: B
authors: Canaud
authors: Lin
authors: L
authors: Tong
authors: Francesca
authors: F
authors: Tentori
authors: Takashi
authors: T
authors: Akiba
authors: Angelo
authors: A
authors: Karaboyas
authors: Brenda
authors: B
authors: Gillespie
authors: Tadao
authors: T
authors: Akizawa
authors: Ronald L
authors: RL
authors: Pisoni
authors: Juergen
authors: J
authors: Bommer
authors: Friedrich K
authors: FK
authors: Port
mesh_terms: D000367:Age Factors; D000368:Aged; D000375:Aging; D001315:Australia; D002170:Canada; D015897:Comorbidity; D005060:Europe; D005260:Female; D019538:Health Care Surveys; D054624:Health Status Disparities; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States