The Challenges of Renal Replacement Therapy in the Elderly

Abstract

Q1 Describe the treatment options for elderly patients.

In theory all patients with established renal failure have the option of hospital haemodialysis, home haemodialysis, peritoneal dialysis, transplantation or conservative care. In practice, no Scottish patients over the age of 80 years are currently being treated by home haemodialysis. There is no theoretical reason why an elderly renal patient should not have a pre-emptive transplant though this also does not happen. If a trial of renal replacement therapy is chosen, this effectively means a choice between hospital based haemodialysis and peritoneal dialysis at home. Studies suggest that with appropriate multidisciplinary support, over 50 % of an elderly population eligible for PD will choose this form of treatment. However, the uptake is much lower. A UK Renal Registry analysis of patients under 65 years on 31/12/2012 showed that 63 % had a functioning transplant, 31 % were treated by haemodialysis, and only 6 % were undergoing PD. In the over 65 s the proportion with a functioning transplant dropped to 27 % with most of the remaining patients receiving haemodialysis (64 %) rather than PD (9 %).