Santoro Domenico, Gitto Lara, Di Iorio Biagio, Savica Vincenzo, Li Vecchi Maurizio, Bellinghieri Guido, De Santo Natale G
Division of Nephrology and Dialysis, University of Messina, Policlinico Universitario, Viale Gazzi, Messina, Italy.
J Nephrol. 2008 Mar-Apr;21 Suppl 13:S118-23.
Dialysis for octogenarian and nonagenarian patients has increased dramatically in recent decades. Worldwide Registries of dialysis and transplantations show how the incidence rate of patients older than 80 years of age is almost doubled. This increase is probably due to liberalisation of acceptance criteria for dialysis, together with the ageing population. In recent years, the Sicilian and Campanian Registries of dialysis and transplantations have also observed a progressive increase in the elderly population. In order to study survival in this class of patients, we performed a study on a sample of Sicilian and Campanian patients. Regarding Sicilian patients, we considered a sample of 497 patients and grouped them into 3 categories of risk: in the first group (low risk) patients included were <70 years old without any co-morbidities; in the second group (average risk), we selected patients between 70 and 80 years old with one or more co-morbidities: in the third group (high risk patients), we included patients aged more than 80 years or with a high number of co-morbidities. The probabilities of survival in the low risk patients after 48 months of treatment was 96.1%; this probability fell to 82.9% for patients included in the high risk group; while the probability of survival for average risk patients was 91.7%. Given the high risk presented by older patients, we focused the second part of our analysis only on octogenarians, studying both Sicilian and Campanian patients. 64 Sicilian patients (33 males and 31 females--51.56% and 48.43% respectively) were observed: and their survival was 81.25% after 48 months. The sample of Campanian octogenarian patients considered for this study included 26 patients (12 males--53.85%--and 14 females--46.15%), observed for a shorter period (36 months). The probabilities of survival after 36 months was 84.61%. To sum up, elderly patients represent a growing reality on dialysis registries in Sicily and Campania. Future research concerning this class of patients should be developed in order to individualize suitable stratification risk indices; knowing patterns and probability of survival might help physicians in the dialysis decision-making process.
