Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2009 May;18(3):252-7.
doi: 10.1097/mnh.0b013e328326f3ac.

Incidence, management, and outcomes of end-stage renal disease in the elderly

Manjula Kurella Tamura  1
Affiliations
Review

Incidence, management, and outcomes of end-stage renal disease in the elderly

Manjula Kurella Tamura. Curr Opin Nephrol Hypertens. 2009 May.

Abstract

Purpose of review: The elderly constitute a substantial and growing fraction of the end-stage renal disease (ESRD) population. We review recent studies on ESRD incidence, management, and outcomes in the elderly.

Recent findings: Rates of treated ESRD among the elderly (>80 years) have risen by more than 50% in the last decade. In studies with a large number of elderly patients, median survival after dialysis initiation is modest, and although a majority have reasonable life expectancy, a substantial minority of elderly patients experience very high early mortality rates after dialysis initiation. Quality of life results are mixed--compared with younger ESRD patients or non-ESRD elderly, mental well being is similar and physical well being is reduced in elderly patients with ESRD. In several studies, elderly patients with ESRD initiating peritoneal dialysis had higher mortality rates than elderly patients with ESRD initiating hemodialysis. Strategies such as nondialytic management of ESRD or dietary protein restriction and delayed dialysis initiation may be alternatives for elderly patients wishing to avoid dialysis initiation, but further studies are needed to determine the patients best suited for these approaches. Quality improvement initiatives in geriatric ESRD care have been successfully implemented in some centers and may ultimately improve care for elderly patients with ESRD.

Summary: These findings should help to clarify some of the risks and benefits of dialysis in the elderly and may be useful in dialysis decision-making and management.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Incidence of dialysis initiation from 1996 to 2003 by year and age group (per 100 000 persons in US population), adjusted for sex and race
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Collins AJ, Foley R, Herzog C, et al. Excerpts from the United States Renal Data System 2007 annual data report. Am J Kidney Dis. 2008;51:S1–S320. - PubMed
    1. seki K, Tozawa M, Iseki C, et al. Demographic trends in the Okinawa Dialysis Study (OKIDS) registry (1971–2000) Kidney Int. 2002;61:668–675. - PubMed
    1. McDonald S, McCredie M, Williams S, Stewart J. Factors influencing reported rates of treated end-stage renal disease. Adv Chronic Kidney Dis. 2005;12:32–38. - PubMed

    1. Kurella M, Covinsky KE, Collins AJ, Chertow GM. Octogenarians and non-agenarians starting dialysis in the United States. Ann Intern Med. 2007;146:177–183. This study on secular trends in dialysis initiation among the very elderly describes a rapid increase in dialysis initiation among the very elderly while at the same time median life expectancy was modest.

    1. Hsu CY, Vittinghoff E, Lin F, Shlipak MG. The incidence of end-stage renal disease is increasing faster than the prevalence of chronic renal insufficiency. Ann Intern Med. 2004;141:95–101. - PubMed