Characteristics and treatment course of patients older than 75 years, reaching end-stage renal failure in France. The PSPA study.

BACKGROUND

The age of patients with end-stage renal disease is increasing in Europe and United States. In France, patients older than 75 years represent 40% of the patients who start renal replacement therapy (dialysis or renal transplantation). In these elderly patients with many comorbidities, the benefit of dialysis remains controversial. To provide clear information to patients about diagnosis, prognosis, and all treatment options, more data are needed on their clinical characteristics, therapeutic projects, and outcome.

METHODS

Researchers present here the ongoing Parcours de Soins des PersonnesAgées (PSPA) multicenter prospective study, which includes 581 patients with a mean age of 82±5 years and an estimated glomerular filtration rate (by sMDRD) of 14±4ml/min/1.73m(2) without dialysis.

RESULTS

Despite a high prevalence of associated comorbidities, most of the patients are autonomous, living at home. Less than 10% are followed jointly by a nephrologist and a geriatrician. At inclusion, postponed dialysis decision due to stable estimated glomerular filtration rate was reported in 43%, 17% of the patients are under evaluation, the decision to start dialysis was chosen in 24% of the patients, nondialysis decision was decided in 16%.

CONCLUSIONS

Geriatricians' expertise may help nephrologists to identify patients at high risk of early death for who nondialysis care may be discussed. They also may be more able to evaluate and anticipate the impact of such restricting treatments. A multidisciplinary approach of these old and frail patients' needs to be reinforced.