Mignon F, Michel C, Mentre F, Viron B
Hôpital Tenon, AURA, Paris, France.
Kidney Int Suppl. 1993 Jun;41:S18-26.
Aging will be a serious social problem in the future. The number of patients of 75 years and over with end-stage renal disease (ESRD) is bound to increase. The time has come to pay greater attention to their problems before and during dialysis treatment. Prevention of ESRD is an important challenge, especially in the field of vascular diseases which are the main cause of ESRD in the elderly. The exact number of elderly patients who will require dialysis in the next few years is difficult to foresee. It is only when the incidence of patients starting dialysis at 75 and over levels off that we may assume that elderly patients are no longer rejected from treatment; we could then assess the actual need in dialysis facilities. In elderly dialysis patients, mortality remains high. Improvements in geriatric medicine and dialysis techniques should contribute to better results in future years. As it is almost impossible to predict the survival and how an elderly patient will adapt to treatment, it appears more ethical to propose a trial of dialysis treatment, except in cases of severe dementia or malignancy. This large acceptance rate implies admitting that withdrawal from dialysis must sometimes be considered.
老龄化将成为未来一个严重的社会问题。75岁及以上的终末期肾病（ESRD）患者数量必将增加。现在是时候更加关注他们在透析治疗前和治疗期间的问题了。预防ESRD是一项重要挑战，尤其是在血管疾病领域，血管疾病是老年人ESRD的主要原因。未来几年需要透析的老年患者的确切数量难以预见。只有当75岁及以上开始透析的患者发病率趋于平稳时，我们才可以认为老年患者不再被拒绝治疗；然后我们才能评估透析设施的实际需求。在老年透析患者中，死亡率仍然很高。老年医学和透析技术的改进应有助于在未来几年取得更好的效果。由于几乎不可能预测老年患者的生存期以及他们将如何适应治疗，除了严重痴呆或恶性肿瘤的情况外，提议进行透析治疗试验似乎更符合伦理。这种高接受率意味着必须承认有时需要考虑停止透析。
