Electronic letters to:

Research:
Sarbjit Vanita Jassal, MB BCh MD, Lilyanna Trpeski, MPH MD, Naisu Zhu, MD, Stanley Fenton, MD, and Brenda Hemmelgarn, PhD MD
Changes in survival among elderly patients initiating dialysis from 1990 to 1999
CMAJ 2007; 177: 1033-1038 [Abstract] [Full text] [PDF]
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[Read eLetter] Tailoring care to the elderly population on hemodialysis
Manish M Sood   (5 November 2007)

Tailoring care to the elderly population on hemodialysis 5 November 2007
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Manish M Sood
St Boniface general Hospital, University of Manitoba

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Re: Tailoring care to the elderly population on hemodialysis

msood{at}sbgh.mb.ca Manish M Sood

I applaud the effort by Jassal et al as they report changes in survivial among elderly patients intiating dialysis between 1990-1999. Their paper captures the commonly observed trends seen in hemodialysis units. Namely, that our patient demographic is progressively aging and increasing complex with respect to comorbidities.The challenge facing nephrologists now is where do we go from here?

Despite the rapid rise in survival and patients intiating dialysis over the age of 65, there has been little, if any, changes addressing their unique needs. Frank open discussions regarding prognosis and quality of life are rare. A survey by Fine et all of 100 new dialysis patients showed the overwhelming majority (97%) want to be given detailed life expectancy information. Unfortunately this is rarely the case. Intiating dialysis in the elderly with chronic renal failure will lead to one of two outcomes: death on dialysis (majority) or death after withdrawal of dialysis (minority). This final common path should be openly disclosed in a compassionate manner with the ultimate decision residing with an informed patient. Furthermore elderly dialysis patients are more likely to suffer from vascular disease leading to coronary artery disease, left ventricular dysfunction and poor vascular access. Lastly they are more vunerable to malnutrition and deconditioning. Yet specific interventions directed at this issues is lacking. Maintaining independance and quality of life with strength training, nutritional support and longer, gentler dialysis therapies should be explored.

As our demographic changes over time, we as nephrologists should tailor our treatments to our population.

Manish M Sood MD FRCPC Clinical Nephrologist Manitoba Renal Program St Boniface General Hospital

Reference Fine A, Fontaine B, Krausher MM, Rich BR. Nephrologists should voluntarily divulge survival data to potential dialysis patients:a questionnaire study. Perit Dial Int. 2005. 25(3):269-73.

Conflict of Interest:

None declared