A Clinical Study of Hemodialysis in the Elderly

ABSTRACT

BACKGROUND: As Korea advances into the ageing society, the number of elderly person receiving dialysis has increased. Two-year survival rate of the patients who received hemodialysis was 84.2% in 1996. But there is no estimate on the survival rate of the patients over age 65. Elderly persons are more prone to have dialysis complications and have more problems in cardiovascular system. The following is a 5-year-study on the elderly ESRD patients who underwent hemodialysis. METHODS: In this retrospective study, 825 patients had received hemodialysis at Seoul Paik Hospital from Jan. 1997 to Dec. 2002. The elderly group was consisted of 35 patients over age 65 and the non-elderly group was consisted of 43 patients below age 65 who received hemodialysis. And they had been traced for more than six months. The patient`s age, sex, occupation and whether the patient was married or not, had been compiled. Also taken into consideration was etiology, complications, initial laboratory data, electrocardiography, abdominal sonography, echocardiography, ftmndus examination, cause of death. RESULTS: Average age of the elderly and the non-elderly group was 70.1 and 47.4 years(p<0.00). nd parathyroid hormone were different between the two groups(p<0.05), other laboratory data were not. Prevalence of diabetes mellitus and hypertensive nephrosclerosis were not either. The overall 1, 2, 5 year survival rate was 97.3%, 93.4%, 73.7%. And the 5-year survival rate was 88.6% in the non-elderly group and it was 54.1% in the elderly group(Kaplan-Meier method). Causes of death were sepsis(n=3), cerebrovas cular accident(n=2), myocardial infarction, pneumonia and gastrointestinal bleeding, malignancy, withdrawal of treatment(1 patient respectively) in the elderly group and were myocardial infarction, withdrawal of treatment in the non-elderly group(n=2). CONCLUSION: The 5-year survival rate of the elderly patients was lower than the non-elderly(p<0.001). The contributing factor of death was not etiology but cormobid condition according to ageing process and socioeconomic circumstance. In other words, it was cardiovascular disease, infection due to impaired immune system and withdrawal of treatment due to economic problems. So it would be necessary to monitor carefully these factors for the elderly hemodialysis patients to improve survival..