Research suggests that older adults who are frail and unable to dress, toilet, bathe, eat on their own or get out of bed in the morning also tend not to live long on dialysis.
“If someone can’t perform multiple activities of daily living, you need to be introspective about whether dialysis adds to their longevity,” said Dr. Leslie Spry, medical director of The Dialysis Center of Lincoln, in Nebraska, and a spokesman for the National Kidney Foundation. “If they’re otherwise relatively healthy and getting around all right, that’s another matter altogether.”
One simple question that draws on the doctor’s clinical judgment — “Would you be surprised if Mr. Smith died within the next six months?” — turns out to be highly predictive of who will survive.
New research from the Mayo Clinic, presented last month at the annual meeting of the American Society of Nephrology, suggests other considerations. The study looked at 379 patients aged 75 and older at the Rochester, Minn., medical center between 2007 and 2011. Slightly more than three-quarters of them began dialysis in the hospital after an acute exacerbation of chronic kidney disease, a severe infection, or an acute kidney injury following surgery.
Those who started dialysis in the intensive care unit (60 percent of the hospital population) did especially poorly. Only 27 percent survived the next six months; 23 percent were alive at one year. Patients who started dialysis in the hospital but outside the I.C.U. had better results initially, but those worsened over time: 12 percent died in the first six months, but only 59 percent were alive after a year.
kidneyhospitalabroad@hotmail.com
“If someone can’t perform multiple activities of daily living, you need to be introspective about whether dialysis adds to their longevity,” said Dr. Leslie Spry, medical director of The Dialysis Center of Lincoln, in Nebraska, and a spokesman for the National Kidney Foundation. “If they’re otherwise relatively healthy and getting around all right, that’s another matter altogether.”
One simple question that draws on the doctor’s clinical judgment — “Would you be surprised if Mr. Smith died within the next six months?” — turns out to be highly predictive of who will survive.
New research from the Mayo Clinic, presented last month at the annual meeting of the American Society of Nephrology, suggests other considerations. The study looked at 379 patients aged 75 and older at the Rochester, Minn., medical center between 2007 and 2011. Slightly more than three-quarters of them began dialysis in the hospital after an acute exacerbation of chronic kidney disease, a severe infection, or an acute kidney injury following surgery.
Those who started dialysis in the intensive care unit (60 percent of the hospital population) did especially poorly. Only 27 percent survived the next six months; 23 percent were alive at one year. Patients who started dialysis in the hospital but outside the I.C.U. had better results initially, but those worsened over time: 12 percent died in the first six months, but only 59 percent were alive after a year.
kidneyhospitalabroad@hotmail.com
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