Dialysis therapy in the elderly patient.

It is clear that an increasing number of elderly patients will require ESRD care as the decade proceeds. Currently available data suggest that outcomes on HD and CPD are similar in this patient group, although the data in elderly diabetics are not all in. A number of questions remain to be answered, however: (1) Can severity indices be developed so that patients can be properly matched for co-morbid conditions? This is essential if firm conclusions about the outcome of one modality compared to another can be drawn. (2) Is survival of elderly diabetics worse on CPD compared to HD? If so, is this because of differences in patient selection or co-morbidity or in the effects of the modality? (3) Can a simple, easy to use modality selection algorithm be developed for the elderly ESRD patient? (4) What factors add to the risk of morbidity and mortality in elderly ESRD patients, and how they can be modified? (5) What is the incidence of malnutrition in elderly ESRD patients? How does it relate to morbidity and mortality? Does it differ from those on HD compared to CPD? (6) Are there elderly patients who should not be started on dialysis? How can they be identified?