The Survival of Elderly Patients on Haemo- Dialysis: A Single Center Study from Rural North Karnataka 1598-1600
Pramila Devi R.
Associate Professor, Dept. of Medicine,
Bagalkot- 587102. Karnataka. India
Introduction: Dialysis and transplantation prolong the survival and the quality of life in patients with chronic kidney disease (CKD). There are no published data on the survival of elderly patients of over 65 years of age, who are on dialysis. Because of several social, economical and practical reasons (mentioned below), not many elderly chronic kidney disease patients opt for dialysis. It is worthwhile to look into the data of the survival of elderly CKD patients on dialysis to justify the treatment.
Materials and Methods: All adult patients who were aged 60 years and above, who continued dialysis for more than one month were included in the study which was conducted in Department of Medicine in the S.Nijalingappa Medical College and HSK Hospital and Research Center between 1st May 2005 and 31st March 2011 The patients with ESRD were prospectively followed up and a survival analysis was done.
Results and Conclusions: The total number of patients who were undergoing dialysis during this period, who were aged 60 years and above after the above mentioned criteria, were 23. All were ambulant, not opting for renal transplant and willing for maintenance HD regularly, at least twice weekly and they were taking regular medications and erythropoietin. Very few had co morbid factors. The mean age of the elderly patients was 63+2.7 years. Elderly males constituted 82.6 % (19/23) of the patients and in them 68.2% were diabetics. 17.4% (4/23) of the patients were elderly females and in them, 50% were diabetics. The mean period for which they were on dialysis was 14.7 months. As expected, their haemoglobin and calcium levels were lower and these were corrected accordingly. A 1 year survival was seen in 34.75% (8/23) patients and a 2 year survival was seen in 26 % ( 6/23) patients. Our study showed reasonably good 1 year survival rates which were in par with the rates of other Indian studies. The survival in our set up can be improved by proper patient selection, by creating awareness among the patients and their family members for an early initiation of the ESRD patients on haemodialysis before the complications occur, and by giving a maintenance haemodialysis weekly twice, even though they are asymptomatic. In addition, proper management of the co morbid factors, maintaining adequate haemoglobin levels by using erythropoietin and providing good nutrition and concessional rates for MHD for the elderly in accordance with the state government norms are the other modalities for the improvement of their survival in rural conditions.