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Dialysis therapy in the elderly patient. 1993

A R Nissenson
Department of Medicine, UCLA School of Medicine.

It is clear that an increasing number of elderly patients will require ESRD care as the decade proceeds. Currently available data suggest that outcomes on HD and CPD are similar in this patient group, although the data in elderly diabetics are not all in. A number of questions remain to be answered, however: (1) Can severity indices be developed so that patients can be properly matched for co-morbid conditions? This is essential if firm conclusions about the outcome of one modality compared to another can be drawn. (2) Is survival of elderly diabetics worse on CPD compared to HD? If so, is this because of differences in patient selection or co-morbidity or in the effects of the modality? (3) Can a simple, easy to use modality selection algorithm be developed for the elderly ESRD patient? (4) What factors add to the risk of morbidity and mortality in elderly ESRD patients, and how they can be modified? (5) What is the incidence of malnutrition in elderly ESRD patients? How does it relate to morbidity and mortality? Does it differ from those on HD compared to CPD? (6) Are there elderly patients who should not be started on dialysis? How can they be identified?

UI MeSH Term Description Entries
D007676 Kidney Failure, Chronic The end-stage of CHRONIC RENAL INSUFFICIENCY. It is characterized by the severe irreversible kidney damage (as measured by the level of PROTEINURIA) and the reduction in GLOMERULAR FILTRATION RATE to less than 15 ml per min (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002). These patients generally require HEMODIALYSIS or KIDNEY TRANSPLANTATION. ESRD,End-Stage Renal Disease,Renal Disease, End-Stage,Renal Failure, Chronic,Renal Failure, End-Stage,Chronic Kidney Failure,End-Stage Kidney Disease,Chronic Renal Failure,Disease, End-Stage Kidney,Disease, End-Stage Renal,End Stage Kidney Disease,End Stage Renal Disease,End-Stage Renal Failure,Kidney Disease, End-Stage,Renal Disease, End Stage,Renal Failure, End Stage
D008297 Male Males
D009017 Morbidity The proportion of patients with a particular disease during a given year per given unit of population. Morbidities
D010531 Peritoneal Dialysis, Continuous Ambulatory Portable peritoneal dialysis using the continuous (24 hours a day, 7 days a week) presence of peritoneal dialysis solution in the peritoneal cavity except for periods of drainage and instillation of fresh solution. CAPD,Continuous Ambulatory Peritoneal Dialysis
D011788 Quality of Life A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral, social environment as well as health and disease. HRQOL,Health-Related Quality Of Life,Life Quality,Health Related Quality Of Life
D004992 Ethics, Medical The principles of professional conduct concerning the rights and duties of the physician, relations with patients and fellow practitioners, as well as actions of the physician in patient care and interpersonal relations with patient families. Medical Ethics
D005260 Female Females
D006435 Renal Dialysis Therapy for the insufficient cleansing of the BLOOD by the kidneys based on dialysis and including hemodialysis, PERITONEAL DIALYSIS, and HEMODIAFILTRATION. Dialysis, Extracorporeal,Dialysis, Renal,Extracorporeal Dialysis,Hemodialysis,Dialyses, Extracorporeal,Dialyses, Renal,Extracorporeal Dialyses,Hemodialyses,Renal Dialyses
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly

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