Problems in the initial stage of dialysis in elderly patients

• Published in: Journal of Japanese Society for Dialysis Therapy Vol. 25; no. 1; pp. 57 - 61
• Main Authors: Yasumori, Ryoukichi, Kubota, Shigehiro, Takashima, Kazuhiko, Oozono, Yoshiyuki, Hara, Kohei, Taura, Koichi, Harada, Takashi
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society for Dialysis Therapy 1992
• ISSN: 0911-5889; 1884-6211; 1884-6211
• DOI: 10.4009/jsdt1985.25.57

In order to analyze problems arising from the initiation of hemodialysis (HD) in elderly patients, we conducted a study of 87 such patients. Subjects included 47 males and 40 females, all of whom were treated by HD during the 10-year period from 1981 to 1990. All of the patients were over 70 and their mean age was 76.3 years. The ongoing renal diseases were nephrosclerosis in 44, chronic glomerulonephritis in 19, diabetes in 12, polycystic kidney in 4, pyelonephritis in 4 and other diseases in the remaining 4 cases. HD was initiated in 8 patients who were clinically asymptomatic. In the other cases, the initiation of HD was required to treat azotemia, oliguria, heart failure, hyperkalemia, acidosis, anasarca, appetite loss, etc. One month later, 26 of these patients had died, the prognosis was maintenance of HD in 58, and HD had been discontinued in 3. At one year, however, a total of 56 patients had died. The patients who died within one month were characterized by lower blood pressure, decreased urine volume, higher BUN levels and acidosis. Most of these patients had multiple organ failure, infection and coagulopathy. Among the 30 patients with no organ failure, however, there was only one death. These data suggest that in elderly patients early initiation of HD, before the onset of organ failure, will improve both long and short term prognoses.