Dialysis by the book? Treatment of renal failure in a 101-year-old patient

Abstract

While dialysis historically began as treatment intended for younger patients, it has, over time, increasingly been extended to treat elderly patients with a high comorbidity burden. Data on the outcomes of dialysis in these patients show that in some cases it confers no benefit and may be associated with functional decline. We describe a 101-year-old male patient with chronic kidney disease (CKD), admitted to the intensive care unit (ICU) with exacerbation of heart failure and sepsis. He experienced acute deterioration of renal function, with oliguria and acidosis. The patient's healthcare proxy insisted that dialysis be initiated despite his extremely advanced age, citing the patient's devout religious beliefs. He underwent 56 dialysis treatments over the course of ∼4 months after which he died as a result of septic and cardiogenic shock. Our case is unique, in that it may represent the oldest individual ever reported to start haemodialysis. It illustrates the ever-growing clinical and ethical challenges posed by the treatment of renal failure in the geriatric population.

Haemodialysis in the Octogenarian: More Than a Decade of Experience from a Single UK Centre

“…Historically renal replacement therapy (RRT) was only considered a feasible treatment option in younger patients with little comorbidity [1,2]. In 1984 a survey revealed that half of nephrologists would not offer dialysis to a 50-year-old with ischaemic heart disease [3].…”

“…Two decades later, Oreopoulous et al warned that 21st century nephrologists will be mainly practicing geriatric medicine and nephrologists needed to prepare for this "coming of age" [4]. True to that statement, today HD is considered a viable treatment option for all ages including the very elderly as a result of positive advances in medicine [2].…”