Hemodialysis in Older Adults: Clinical Considerations and Outcomes

Abstract

Aims: It is well established that life expectancy has increased globally, leading to a growing proportion of elderly patients requiring dialysis. In countries such as the US and the UK, the cost of managing these patients has risen substantially, as a significant portion of healthcare expenditure is allocated to dialysis treatment. The aim of the study was to determine whether renal replacement therapy is worthwhile in patients with very advanced age and whether it is easily achievable, providing a satisfactory life for the patient. Methodology and Material: The survival of 69 elderly patients (> 80 years aged 80-96 years old, at the beginning of dialysis, who were treated in a hemodialysis unit from 2004-2019, was studied prospectively. Results: Overall patient survival was favorable. Participants aged ≥85 years at the initiation of hemodialysis had a median survival of 12 months (range: 1–75 months), whereas those aged <85 years had a median survival of 18.5 months (range: 1–120 months). Serum C-reactive protein levels were significantly lower among patients younger than 85 years compared with those aged 85 years or older; however, this difference was not associated with survival outcomes. A total of 52.2% of patients younger than 85 years reported a good quality of life, compared with 21.7% of those aged 85 years or older. Smoking status, hypertension, and diabetes mellitus were not significantly associated with survival. In contrast, cardiovascular disease as the underlying cause of chronic kidney disease showed a positive correlation with increased mortality risk. Conclusions: Our study demonstrates that elderly patients undergoing hemodialysis have favorable survival outcomes and maintain a good quality of life in a considerable proportion of cases. These findings suggest that the initiation of hemodialysis in elderly individuals should not be discouraged solely based on age, as many can continue to live with dignity and satisfactory well-being for several years.