Hemodialysis in the Elderly
During the last decade, the number of patients starting renal replacement therapy has increased for all ages, but the increase for patients over 65 years old has been particularly dramatic.Objective: The aim of our study was the analysis of the outcome of all the patients who were over 65 years of age at the time they started chronic hemodialysis, in our Center (n, 52).Methods: A total of 76 patients were treated by the chronic hemodialysis program of 251 Hellenic Air Force and VA General Hospital, between 1992 and 2002, while totally 309 patients were offered dialysis at this time. We found that 52 of them (68.4%) were over 65 years old [40 male (76.9%), 12 female (23.1%)].Results: Elderly patients manifest more often intradialytic complications, such as hypotensive episodes (28.8%) and arrhythmias (23.1%), due to their hemodynamic instability. Polypharmacy is a big deal for dialysis patients, especially elderly ones. Each patient was taking 9.1 PO and 1.9 IV medications on average, per day. Most of them (84.6%) required recombinant human erythropoietin. The most common co-morbid factors we observed in this population were cardiovascular diseases (36.5%), neurological problems, respiratory failure, bone disease, malignancy (17.3%), depression, malnutrition, and infections (30.8%). Deaths were often associated with more than one morbid factors. Survival and the quality of life in the elderly patients on hemodialysis are frequently acceptable. The 1, 3 and 5-year patient survival rates during 1990–2000 were 63.4%, 56.1%, and 26.8%.Conclusion: We believe that if there are no extracontraindications, elderly patients can benefit from hemodialysis, taking into consideration that we should adapt the therapy to the geriatric special needs.
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