HDCN Article Review/Hyperlink

Rohrich B, Asmus G, von Herrath D, Schaefer K

Is it worth performing kidney replacement therapy on patients over 80?

Nephrol Dial Transplant (Dec) 12:2412-2413 1996

At a time when a substantial minority of patients presenting for dialysis are > 80 years of age, it is necessary to look at survivals in this cohort. The authors looked at survivals in 82 patients who were prevalent in their dialysis center between 1981 and 1996. The average survival was 26 months, and interestingly, was the same for patients aged 80-83 years, 84-86 years, and 87- 92 years at time of commencing dialysis. Overall one and two year mortalities were 30 and 50%. However, when the results were broken up into patients commencing dialysis before and after 1990, the later patients fared much better, with one and two year gross mortality rates of 20 and 40%, respectively.

Comment: The data reinforce the notion that patients who are very elderly may represent an especially hardy group of individuals. The fact that this clinic had gross mortality in 80+ year olds similar to the crude mortality of all patients in the US gives one pause. Thirteen of their patients were diabetic, and these patients had a slightly BETTER survival than their non- diabetic counterparts. This is either an interesting anomaly, or perhaps points to the fact that diabetes in the extreme elderly may have different prognostic implications than in younger patients. (John T. Daugirdas, M.D., University of Illinois at Chicago)