Hemodialysis in Patients Over 80 Years

Abstract

Background: In Germany, every fifth patient starting dialysis is now 80 years of age or older. The question that is currently relevant is not whether we have to treat patients who are older than 80. Rather the question now is how to treat this elderly group of patients. Methods: Single centre data of all dialysis patients aged over 80 were analyzed with regard to survival, social circumstances, vascular access, and pre-dialysis nephrology care. Results: Between 2001 and 2012, 76 patients over 80 years started chronic ambulatory hemodialysis treatment. One-year survival was 87%, 3-year survival 52%, 5-year survival 27% and 10-year survival 9%. Patients (n = 55) with more than 3 months of nephrological care prior to dialysis (3-161 months, median 31 months) survived significantly longer then patients (n = 21) having had less than 3 months contact with nephrologists. On 31st December 2012 there were 38 patients aged ≥80 (median age 84, 80-95 years) in the chronic hemodialysis program accounting for 19% of all dialysis patients of this center. Thirty patients (79%) had been in long-term nephrological care prior to dialysis initiation (3-161 months, median 45 months). Thirty one patients (82%) started the first dialysis treatment with a functioning shunt access. Conclusion: Long-term pre-dialysis nephrology care is of most importance for successful dialysis treatment in the elderly, especially in octogenarians and nonagenarians. It enables the early establishment of functioning vascular access and careful scheduling of first dialysis treatment and increases survival. The long-term use of catheters can be avoided in almost all patients above the age of 80.

Comorbidities, Hospitalization, and Living Status of Dialysis Patients Over 80 Years

“…This is the same in patients with impaired mobility [8] . But independent patients have a good prognosis on dialysis [10][11][12][13][14] . In the context of German standard care, most elderly patients choose to start dialysis.…”

“…After such a long time of nephrology care, almost all elderly patients decided in favor of dialysis initiation. And last but not least, survival rates of very old dialysis patients are increasing, especially in patients with long-term pre-dialysis nephrology care [10] . The median time on dialysis in our patients over 80 was nearly 5 years ( table 1 ), and every fifth patient had been dialyzed for more than 10 years.…”

“…Duration and intensity of pre-dialysis nephrology care influence the outcome [23,24] , especially in patients over 80 years [10,11,25] . In our opinion, early and intensive nephrology pre-dialysis care is the key to successful dialysis treatment in octogenarians and nonagenarians, and in contrast to other factors, it is well-modifiable [10] .…”

“…If patients decided to commence chronic dialysis treatment, a vascular surgeon was involved and the vascular access was created in time. We aimed at carrying out the first dialysis session in an outpatient setting using an arteriovenous (AV)-shunt [10] .…”

“…In the first months after starting dialysis, mortality is higher in very elderly patients [7][8][9] . From the sixth month onward, the monthly hazard of death persists [7] , but the patients may also remain stable for many years to come [4,[10][11][12][13][14] . Finally, in all octogenarians and nonagenarians, we always face the process of dying including frailty, loss of autonomy, and heavy burden.…”