Half Elderly Starting Dialysis After Age 75 Die
Within Year Finds Mayo Clinic
New evidence to to help guide shared decision-making
among the patient, family members and care team -
Nov. 8, 2013 - Half of elderly patients who start
dialysis after age 75 will
die within one year, according to new research from
Mayo Clinic finds that.
Although, age alone was not a good measure. The findings will being
presented this week at the American
Society of Nephrology's Kidney Week 2013 in Atlanta.
"Many elderly patients and their families feel that
they have no choice but to start dialysis, with several expressing
regret from having initiated therapy," says primary care physician
Bjorg Thorsteinsdottir, M.D.,
lead study author and a health care delivery scholar with the
Mayo Clinic Robert D. and Patricia
E. Kern Center for the Science of Health Care Delivery.
"The goal of our study was to develop evidence
about dialysis outcomes to help guide shared decision-making among the
patient, family members and care team."
Researchers reviewed four years of medical records
for 379 patients who were at least 75 years old when they began dialysis
treatment at Mayo Clinic in Rochester.
The majority (76 percent) started
dialysis while in the hospital for a chronic illness or sudden medical
event such as pneumonia.
Mortality was very high, with 40 percent of
patients dying within six months. The highest mortality rates were seen
in patients who started dialysis in the intensive care unit. Only 27
percent were alive after six months.
Patients who started dialysis in the hospital often
were not able to return home. Of the patients admitted to the hospital
from home, 28 percent died while in the hospital or were discharged to
hospice, 28 percent were discharged to a nursing home, and only 37
percent were able to return home to independent living.
The graph shows patients age 75 or older who start dialysis in
the intensive care unit have significant risk of dying within
one year of hospitalization. Groups starting in other settings
Age alone was not a good predictor of survival, and
healthier elderly patients did better. Most deaths were preceded by a
decision to withdraw life support, including dialysis.
"We hope that these study results will help inform
the difficult decisions that patients and family members must make about
whether or not to begin dialysis," says Dr. Thorsteinsdottir. "We want
to make sure that the treatment is congruent with our patients' goals
About Mayo Clinic
Mayo Clinic is a nonprofit worldwide leader in
medical care, research and education for people from all walks of life.
For more information, visit
Mayo Patient Care
American Society of Nephrology's
Kidney Week 2013
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