Background: Over the last decade, the age of dialysis patients has been increasing
steadily in several units in Canada. Our main objective was to assess prevalence,
co-morbidity and outcome of ESRD patients over 75 years old at the beginning of dialysis
treatment in our center. As a group, they were compared to younger dialysis patients
treated simultaneously. Methods: In the last 5 years, all cases beginning dialysis
in our institution who were above 75 years of age were reviewed, as well as cases
aged between 50 and 60 years who started dialysis during the same period. Between
January 1996 and December 2000, among a total of 429 new chronic dialysis patients,
67 ESRD patients over 75 years (15.6%) and 66 patients between 50 and 60 years (15.4%)
began dialysis treatment. Results – Primary and Secondary: Diabetes was present
in 37% of elderly and in 56% of the younger patients. Younger patients had been referred
earlier to our nephrologists than the older ones (42 vs. 27%). Elderly were more frequently
treated by hemodialysis than peritoneal dialysis (81 vs. 19%) when compared to their
younger counterparts (65 vs. 35%). Long-term catheters for hemodialysis were used
more often in elderly patients. No renal transplantation were performed in older patients
while 7 younger patients received a renal graft. Survival rates after 1 and 3 years
were, respectively, 93 and 74% for patients between 50 and 60 years, whereas it decreased
to 80 and 45% for those over 75 years (p = 0.002). More than 50% of patients older
than 75 years died within 2 years after starting dialysis; their mean survival was
31 months; patients starting dialysis between 50 and 60 years survived on the average
44 months during the study period. According to the multivariate logistic regression
model, risk factors for increased mortality in the older group were: number of hospitalization
days during the past 3 months (OR 34.8, 95% CI 8.3–145.7, p < 0.001) and lower weight
(OR 16.6, 95% CI 2.0–139.0, p = 0.001). Conclusion: We may conclude that, in our
hands, life expectancy of patients who began dialysis above 75 years is significantly
shorter than for patients for whom dialysis is initiated between age 50 and 60 years,
especially if they have a low weight, lose weight and/or require hospitalization.