Worldwide demographics and future trends of the management of renal failure in the elderly.

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.