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Old age not a barrier for dialysis treatment (p 1543)

November 01, 2000

Favourable survival rates and the prognosis of a good quality of life suggest that old age should not be a barrier to receiving dialysis treatment for kidney failure, concludes research published in this week’s issue of THE LANCET.

Evidence-based health policy is needed to meet the increasing demand for health services among elderly people, particularly for expensive technologies such as renal-replacement therapy. Age is used covertly to ration dialysis, despite the lack of evidence about how elderly people fare on dialysis. Donna Lamping and colleagues from the London School of Hygiene & Tropical Medicine, UK, report the results of the North Thames Dialysis Study (NTDS), a 12-month prospective study designed to assess outcomes (including clinical outcomes, quality of life, and costs) in a large sample of elderly people (70 years or over) on dialysis.

Patients were recruited from four hospital-based renal units. The investigators assessed 1-year survival in 125 incident patients (70-86 years) and disease burden (hospital admissions, quality of life, and costs) in 174 prevalent patients (70-93 years).

Mortality was significantly associated with age 80 years and older and peripheral vascular disease, but not with diabetes, heart disease, cerebrovascular disease, chronic obstructive airways disease, sex, or treatment method. In terms of disease burden, hospital admissions represented a low proportion of costs and was not required by a third of patients. Mental quality of life in elderly dialysis patients was similar to that of elderly people in the general population, and the average annual cost per patient of £20,802 (US$31,200) (68% dialysis treatment, 1% transport, 19% inpatient hospital admissions, 12% medications) was within the range of other life-extending interventions.

Donna Lamping comments: “Our findings suggest that age alone should not be used as a barrier to dialysis. The 1-year survival rates for elderly patients, 71% for all patients who started dialysis and 81% for those who survived 90 days, compare very favourably with the 63% and 85% survival rates reported in a UK study of patients of all ages who were 15 years younger on average than our patients. Indicators of the ability to benefit from treatment, rather than chronological age, should be used to develop policies that ensure equal access to care for all.”

Contact: Professor Charles Normand, Health Services Research Unit, Department of Public Health & Policy, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; T) +44 (0)20 7927 2218; F) +44 (0)20 7580 8183; E) charles.normand@lshtm.ac.uk

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