International Urology and Nephrology

, Volume 32, Issue 1, pp 127–135 | Cite as

Hemodialysis in elderly patients

  • Wendy W. Brown
Hemodialysis Geriatric Elderly Initiation of dialysis Survival Cardiovascular disease Vascular access Medical ethics 


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  1. 1.
    US Renal Data System [US RDS]. Annual data report, Bethesda MD: National Institutes of Health, 1998.Google Scholar
  2. 2.
    Nissenson AR. Peritoneal dialysis in geriatric patients: an overview and introduction. Adv Perit Dial 1990; 6: 1.Google Scholar
  3. 3.
    Porush JG, Faubert RF. Chronic renal failure. In: Porush JG, Faubert RF, editors. Renal disease in the aged. Boston: Little Brown, 1991: 285–313.Google Scholar
  4. 4.
    Glickman JF, Kaiser DL, Bolton WK. Aetiology and diagnosis of chronic renal insufficiency in the aged: the role of renal biopsy. In:Macias-Nuñ ez JF, Cameron JS, editors. Renal function and disease in the elderly. London: Butterworths, 1987: 485–508.Google Scholar
  5. 5.
    Brown WW, Davis BB, Spry LA, et al. Aging and the kidney. Arch Intern Med 1986; 146: 1790–1796.PubMedCrossRefGoogle Scholar
  6. 6.
    Brown WW. The geriatric dialysis patient. In: Henrich WL, editor. Principles and practices of dialysis, chapter 31, 2nd edition. Baltimore: Williams and Wilkins, 1999; 460–476.Google Scholar
  7. 7.
    Winchester JF, Rakowski TA. End-state renal disease and its management in older adults. In: Beck LH, editor. Genitourinary problems. Clinics in geriatric medicine. Philadelphia: W. B. Saunders Company, 1998; 255–265.Google Scholar
  8. 8.
    Rowe JW, Andres R, Tobin JD. Age-adjusted normal standards for creatinine clearance in man. Ann Intern Med 1976; 84: 567–569.PubMedGoogle Scholar
  9. 9.
    Williams P, Ruch DR. Geriatric polypharmacy. Hosp Prac 1986; 21: 104.Google Scholar
  10. 10.
    Chester AC, Rakowski TA. Argy WP et al. Hemodialysis in the eighth and ninth decades of life. Arch Intern Med 1979; 139: 1001–1005.PubMedCrossRefGoogle Scholar
  11. 11.
    Westlie L, Umen A, Nestrud S, Kjellstrand CM. Mortality, morbidity and life satisfaction in the very old dialysis patient. Trans Am Soc Artif Intern Organs 1984; 30: 21–30.PubMedGoogle Scholar
  12. 12.
    Rotellar E et al. Must patients over 65 be haemodialyzed? Nephron 1985; 41: 152–156.PubMedGoogle Scholar
  13. 13.
    Schaefer K et al. Optimum dialysis treatment for patients over 60 years with primary renal disease. Survival data and clinical results from 242 patients treated either by hemodialysis or hemofiltration. Proc Eur Dial Transplant Assoc Eur Renal Assoc 1985; 21: 510–523.Google Scholar
  14. 14.
    Panarello G, De Baz H, Cecchin E, Tesis F. Dialysis for the elderly: Survival and risk factors. Adv Perit Dial 1989; 5: 49–51.PubMedGoogle Scholar
  15. 15.
    Brunner FP, Selwood NK. Results of renal replacement therapy in Europe, 1980-1987. Am J Kidney Dis 1990; 15: 384–396.PubMedGoogle Scholar
  16. 16.
    Valderrabaño F, Berthoux FC, Jones EHP, Mehls O. Report on management of renal failure in Europe, XXV, 1994 End Stage Renal Disease and Dialysis Report. Nephrol Dial Transplant 1996; 11(Suppl 1): 2–21.PubMedGoogle Scholar
  17. 17.
    Okada M.Mortality in chronic hemodialysis patients in Japan. Am J Kidney Dis 1990; 15: 410–413.Google Scholar
  18. 18.
    Disney APS. Dialysis treatment in Australia, 1982-1988. Am J Kidney Dis 1990; 15: 402–409.PubMedGoogle Scholar
  19. 19.
    Posen GA, Jeffrey JR, Fenton SSA, Arbus GS. Results from the Canadian Renal Failure Registry. Am J Kidney Dis 1990; 15: 397–401.PubMedGoogle Scholar
  20. 20.
    US Renal Data System [US RDS]. Annual data report. Bethesda MD: National Institutes of Health, 1991.Google Scholar
  21. 21.
    Iseki K et al. Low diastolic blood pressure, hypoalbuminemia, and risk of death in a cohort of chronic hemodialysis patients. Kidney Int 1997; 51: 1212–1217.PubMedGoogle Scholar
  22. 22.
    Furth S, Hermann JA, Powe NR. Cardiovascular risk factors, comorbidity, and survival outcomes in black and white dialysis patients. Sem Dial 1998; 11: 102–105.Google Scholar
  23. 23.
    Mignon F et al. The management of uraemia in the elderly: treatment choices. Nephrol Dial Transplant 1995; 10(Suppl 6): 55–59.PubMedGoogle Scholar
  24. 24.
    Becker BN, Himmelfarb J, Henrich WL, Hakim RM. Reassessing the cardiac risk profile in chronic hemodialysis patients: a hypothesis on the role of oxidant stress and other non-traditional cardiac risk factors. J Am Soc Nephrol 1997; 8: 475–486.PubMedGoogle Scholar
  25. 25.
    Neves PL, Silva AP, Bernardo I. Elderly patients in chronic hemodialysis: risk factors for left ventricular hypertrophy. Am J Kidney Dis 1997; 30: 224–228.PubMedGoogle Scholar
  26. 26.
    Nally JV. Cardiac disease in chronic uremia: investigation. Adv Renal Replacement Ther 1997; 4: 225–233.Google Scholar
  27. 27.
    Foley RN, Parfrey PS. Cardiac disease in uremia: clinical outcome and risk factors. Adv Renal Replacement Ther 1997; 4: 234–248.Google Scholar
  28. 28.
    Tucker B et al. Left ventricular hypertrophy and ambulatory blood pressure monitoring in chronic renal failure. Nephrol Dial Transplant 1997; 12: 724–728.PubMedCrossRefGoogle Scholar
  29. 29.
    Baumgart P et al. Blood pressure elevation during the night in chronic renal failure, hemodialysis and after renal transplantation. Nephron 1991; 57: 293–298.PubMedGoogle Scholar
  30. 30.
    Lipkin GW et al. Ambulatory blood pressure and left ventricular mass in cyclosporin and non-cyclosporin treated renal transplant recipients. J Hypertens 1993; 11: 439–442.PubMedGoogle Scholar
  31. 31.
    Verdecchia P et al. Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. Hypertension 1994; 24: 793–801.PubMedGoogle Scholar
  32. 32.
    Woods JD et al. Vascular access survival among incident hemodialysis patients in the United States. Am J Kidney Dis 1997; 30: 50–57.PubMedGoogle Scholar
  33. 33.
    Schwab SJ. Opinion: what can be done to preserve vascular access for dialysis? Semin Dial 1991; 4: 142–153.Google Scholar
  34. 34.
    Woods JD et al. Predictors of permanent vascular access placement prior to ESRD in U.S. hemodialysis patients. (Abstr.) J Am Soc Nephrol 1996; 7: 1424.Google Scholar
  35. 35.
    Hirth RA et al. Predictors of type of vascular access in patients starting hemodialysis. JAMA 1996; 276: 1303–1308.PubMedCrossRefGoogle Scholar
  36. 36.
    Besarab A et al. Opinion: what can be done to preserve vascular access for dialysis? Semin Dial 1991; 4: 160–162.Google Scholar
  37. 37.
    Glanz S. Opinion: what can be done to preserve vascular access for dialyis? Semin Dial 1991; 4: 157–158.Google Scholar
  38. 38.
    Palder SB et al. Vascular access for hemodialysis. Ann Surg 1985; 202: 235–239.PubMedGoogle Scholar
  39. 39.
    National Kidney Foundation. Dialysis outcome quality initiative clinical practice guideline for vascular access. Am J Kidney Dis 1997; 30(suppl 3): 150–191.Google Scholar
  40. 40.
    Waltzer WC. The surgical approach to dialysis access and transplantation in the elderly. In: Michelis MF, Davis BB, Preuss HG, editors. Geriatric nephrology. New York: Field, Rich and Associates, 1986; 23–128.Google Scholar
  41. 41.
    Churchill DN et al. Canadian hemodialysis morbidity study. Am J Kidney Dis 1992; 19: 214–234.PubMedGoogle Scholar
  42. 42.
    Kario K, Matsuo T, Kobayashahi H. Heparin cofactor II deficiency in the elderly: comparison with antithrombin III. Thromb Res 1992; 66: 489–498.PubMedCrossRefGoogle Scholar
  43. 43.
    Fan P-Y, Schwab SJ. Vascular access: concepts for the 1990s. Editorial Review. J Am Soc Nephrol 1992; 3: 1–11.PubMedGoogle Scholar
  44. 44.
    Kaufman JL. Opinion: what can be done to preserve vascular access for dialysis? Semin Dial 1991; 4: 160–162.Google Scholar
  45. 45.
    Harter HR et al. Prevention of thrombosis in patients on hemodialysis by low-dose aspirin. N Engl J Med 1979; 301: 577–579.PubMedCrossRefGoogle Scholar
  46. 46.
    Domoto DT, Bauman JE, Joist JH. Combined aspirin and sulfinpyrazone in the prevention of recurrent hemodialysis vascular access thrombosis. Thromb Res 1991; 62: 737–743.PubMedCrossRefGoogle Scholar
  47. 47.
    Fox RC, Swazey JP, Cameron EM. Social and ethical problems in the treatment of end-stage renal disease patients. In: Narins RG, editor. Controversies in nephrology and hypertension. New York: Churchill Livingstone, 1984; 45–70.Google Scholar
  48. 48.
    Rothenberg LS. Withholding and withdrawing dialysis from elderly ESRD patients: Part I. A historical review of the clinical experience. Geriatr Nephrol Urol 1992; 2: 109–117.PubMedCrossRefGoogle Scholar
  49. 49.
    Berlyne GM. Over 50 and uremic. Nephron 1982; 31: 189–190.PubMedGoogle Scholar
  50. 50.
    Kjellstrand CM, Tyden G. Inequalities in chronic dialysis and transplantation in Sweden. Acta Med Scand 1988; 224: 149–156.PubMedCrossRefGoogle Scholar
  51. 51.
    Kjellstrand CN, Logan GM. Racial, sexual and age inequalities in chronic dialysis. Nephron 1987; 45: 257–263.PubMedCrossRefGoogle Scholar
  52. 52.
    Rozansky SJ, Jackson K. Rate of change of end-stage renal disease treatment incidence, 1978– 1987. Has there been selection? J Am Soc Nephrol 1992; 3: 1502–1506.Google Scholar
  53. 53.
    Moulton LH et al. Patterns of low incidence of treated endstage renal disease among the elderly. Am J Kidney Dis 1992; 20: 50–62.Google Scholar
  54. 54.
    Wetle T. Age as a risk factor for inadequate treatment. JAMA 1987; 258: 516.PubMedGoogle Scholar
  55. 55.
    Klahr S. Rationing of health care and the end-stage renal disease program. Am J Kidney Dis 1990; 16: 393–395.Google Scholar
  56. 56.
    Cassel CK. Issues of age and chronic care: another argument for health care reform. J Am Geriatr Soc 1992; 40: 404–409.PubMedGoogle Scholar
  57. 57.
    Pawlson LG, Glover JJ, Murphy DJ. An overview of allocation and rationing: implications for geriatrics. J Am Geriatr Soc 1992; 40: 628–634.PubMedGoogle Scholar
  58. 58.
    Cummings NB. Ethical issues in geriatric nephrology: overview. Am J Kidney Dis 1990; 16: 367–371.PubMedGoogle Scholar
  59. 59.
    Lamm RD. High technology health care. Am J Kidney Dis 1990; 16: 378–383.PubMedGoogle Scholar
  60. 60.
    Brodeur D. Ethical issues in geriatric nephrology. Am J Kidney Dis 1990; 16: 372–373.PubMedGoogle Scholar
  61. 61.
    Westlie L, Umen A, Nestrud S, Kjellstrand CM. Mortality, morbidity and life satisfaction in the very old dialysis patient. Trans Am Soc Artif Intern Organs 1984; 30: 21–30.PubMedGoogle Scholar
  62. 62.
    Avram MR, Pena C, Burrell D et al. Hemodialysis and the elderly patient: potential advantages as to quality of life, urea generation, serum creatinine and less interdialytic weight gain. Am J Kidney Dis 1990; 16: 342–345.PubMedGoogle Scholar
  63. 63.
    Kutner NG, Brogan DJ. Assisted survival, aging, and rehabilitation needs: comparison of older dialysis patients and age-matched peers. Arch Phys Med Rehabil 1992; 73: 309–315.PubMedCrossRefGoogle Scholar
  64. 64.
    Kutner NG, Cardenas DD, Bower JD. Rehabilitation, aging and chronic renal disease. Am J Phys Med Rehabil 1992; 71: 97–101.PubMedGoogle Scholar
  65. 65.
    Husebye DG, Kjellstrand CM. Old patients and uremia: rates of acceptance to and withdrawal from dialysis. Int J Artif Organs 1987; 10: 166–172.PubMedGoogle Scholar
  66. 66.
    National Kidney Foundation. Initiation and withdrawal of dialysis in end-stage renal disease: guidelines for physicians and the care team. New York, 1996.Google Scholar
  67. 67.
    The Kidney Foundation of Canada. Living with kidney disease. Montreal, Quebec: The National Office of the Kidney Foundation of Canada, 1995.Google Scholar
  68. 68.
    Moss AH. To use dialysis appropriately: the emerging consensus on patient selection guidelines. Adv Renal Replacement Ther 1995; 2: 175–183.Google Scholar
  69. 69.
    Holley, Finucane TE, Moss AH. Dialysis patients’ attitudes about cardiopulmonary resuscitation and stopping dialysis. Am J Nephrol 1989; 9: 245–251.PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • Wendy W. Brown
    • 1
  1. 1.Internal MedicineSt Louis University School of Medicine, and Clinical Nephrology, St Louis VA Medical CenterSt LouisUSA

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