The number of octogenarians (people aged 80 to 89) and nonagenarians (people 90 to 99) who began dialysis increased from 7,054 people in 1996 to 13,577 people in 2003, according to a new study in the Annals of Internal Medicine.
Overall, one-year survival rates for patients on dialysis did not materially change from 1996 to 2003, remaining at about 50 percent. Survival rates for these very elderly are substantially lower than those previously reported.
Researchers used data from a large national kidney data system. Risk for death was strongly associated with older age, inability to walk (nonambulatory status) and the number of chronic conditions a person had.
Authors suggest that physicians, patients and families considering placing an older person on dialysis should have a discussion that would include realistic estimates of survival, expected quality of life, and the patient's values. It may be, the authors say, that end stage renal disease is "really a reflection of underlying multi-organ system dysfunction" and may be better managed by a palliative approach.
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