ELDERLY PATIENTS FARE POORLY ON DIALYSIS

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ELDERLY PATIENTS FARE POORLY ON DIALYSIS.

Hemodialysis may be an alternative to death, but it does not restore elderly patients with end-stage renal disease to perfect health. The grim prognosis of these patients is shown in two very different types of studies.

In the first study, interviews of 104 elderly inner-city patients indicated that their functional status on a modified Karnofsky scale had deteriorated since initiation of dialysis (at least 6 months earlier). Those with diabetes fared worse: 68 percent were restricted to home except for travel to the dialysis center. Although 87 patients received erythropoietin, and 40 percent of these reported a positive effect, the mean hematocrit did not differ between treated and untreated patients.

The second study analyzed data from all 95,394 Medicare patients 55 years and older who started chronic dialysis in the U.S. between 1982 and 1987. Among diabetic patients, those who started dialysis at 55 to 64 years of age had survival rates of 74 percent at 1 year and 18 percent at 5 years; these rates were just 53 percent and 4 percent for those starting at age 80 to 84. Survival was slightly better when end-stage renal disease was caused by hypertension or glomerulonephritis, and was substantially better for cases caused by polycystic kidney disease.

Comment: Outcomes of hemodialysis in the elderly are still quite poor. These data may help some patients make decisions about whether to start dialysis, and point out the need for better ways to improve rehabilitation and functional status in dialyzed patients.

— TH Lee

Published in Journal Watch General Medicine January 18, 1994