Chronic haemodialysis for very old patients.

There is in the Western World a progressive ageing of the population, and consequently haemodialysis patients are also getting older. Some ethical questions have been raised as a consequence of the economic issues related to the scarcity of available resources. In this paper we review our experience in the treatment of very old chronic haemodialysis patients. Fifty patients (7.2% of our haemodialysis patients) aged over 80 years at the beginning of dialysis were included (f = 25, m = 26, age = 82.6 +/- 0.3 years). In 42% of the patients the aetiology of renal disease was unknown. In the remainder, the aetiology was: interstitial nephritis 26%, hypertensive nephrosclerosis 14%, chronic glomerulonephritis 8%, diabetes 8% and polycystic disease 2%. There was a great comorbidity: intradialytic hypotension 82%, cardiac disease 74%, gastrointestinal disease 32%, cerebrovascular disease 26%. Vascular access related problems were the main reason for hospitalization. The major cause of death was vascular (cardiac and cerebral disease). Actuarial survival was 89%, 78%, 56% and 48% at 6, 12, 24 and 36 months, respectively. We think that haemodialysis is the best available choice for treating very old chronic renal failure patients. However further studies are needed to improve the quality of life of these patients.

[Chronic hemodialysis with acetate in patients over 70 years old]. / Hemodiálise crónica com acetato em doentes com idade superior a 70 anos.

During the last years there has a significant increase of elderly patients included in chronic dialysis programs. No agreement has been reached about the preferable treatment modality. In this study we analyse our experience in the management of patients over 70 years of age undergoing chronic acetate hemodialysis (HDCA). Sixty four of those patients have initiated HDCA between May 1982 and December 1990 (Mean age 75.9 +/- 4.8). The etiology of renal disease was unknown in a significant number of cases. Morbility was largely due to vascular disease (both cardiac and cerebral). Main causes of death were also vascular disease and infections. Actuarial survival was 79.6% at 12 months and 46.3% after 5 years. Although HDCA is associated with a greater morbility it is the most widely used modality of treatment for chronic renal failure in Portugal and in our experience, it is an acceptable method for elderly patients.