In the United States, the primary treatment of older adult end-stage renal disease (ESRD) patients (greater than 75 years of age) is in-center hemodialysis (96 percent) . Continuous ambulatory peritoneal dialysis or continuous cycler peritoneal dialysis (CAPD/CCPD) account for approximately 3.5 percent, while only 0.3 percent are treated with home hemodialysis .
The average age of the patient undergoing dialysis in the United States has been steadily increasingly over the last several decades. In 2000, the average age was approximately 62 years .
The number of older adult patients initiating dialysis is also increasing. In a survey using the United States Renal Data System (USRDS) database, the number of patients 80 years of age and older who initiated dialysis increased from 7054 in 1996 to 13,577 individuals in 2003 . After adjustment for population growth, the rate of dialysis initiation had increased by 57 percent over this time period. However, older adult patients may be less likely to be started on dialysis compared with younger patients with a similar degree of kidney dysfunction. This was suggested by a community-based cohort study of over 1.8 million adults in Alberta, Canada . At a follow-up of 4.4 years, among patients who had an estimated glomerular filtration rate (GFR) of 15 to 29 mL/min per 1.73 m2 at the beginning of the study, the rate of untreated kidney failure (defined as estimated GFR <15 mL/min per 1.73 m2) was over fivefold greater for patients older than 85 years of age compared with those 18 to 44 years. The individual reasons for withholding dialysis cannot be determined from this study .
Important points to consider when evaluating the treatment of older adult patients with ESRD include:
- The life expectancy of such patients
- The effect of ESRD on life expectancy and quality of life