Annals of Internal Medicine tip sheet for February 6, 2007

February 05, 2007

1. Number of Very Elderly Beginning Dialysis Increased Greatly in Last Decade But Only 46 Percent Were Alive One Year Later

The number of octogenarians (people aged 80 to 89) and nonagenarians (people 90 to 99) who began dialysis increased from 7,054 people in 1996 to 13,577 people in 2003, according to a new study (Article, p. 177).

Overall, one-year survival rates for patients on dialysis did not materially change from 1996 to 2003, remaining at about 50 percent. Survival rates for these very elderly are substantially lower than those previously reported.

Researchers used data from a large national kidney data system. Risk for death was strongly associated with older age, inability to walk (nonambulatory status) and the number of chronic conditions a person had.

Authors suggest that physicians, patients and families considering placing an older person on dialysis should have a discussion that would include realistic estimates of survival, expected quality of life, and the patient's values. It may be, the authors say, that end stage renal disease is "really a reflection of underlying multi-organ system dysfunction" and may be better managed by a palliative approach.

2. Sleep Apnea Can Be Diagnosed Without Overnights in a Sleep Lab

Exclusively ambulatory techniques and equipment were as successful at identifying and treating sleep apnea as the current method of polysomnography, which requires several supervised overnight stays in a sleep laboratory (Article, p. 157).

The ambulatory method involved identifying high-probability patients with a standardized clinical assessment and at-home portable sleep monitoring and auto-titration of continuous positive airway pressure (CPAP).

Sixty-eight patients with high likelihood of having sleep apnea were assigned to groups that received polysomnography or the sleep tests at home. Both groups received continuous positive airway pressure at night at home through a CPAP machine with face mask and hose.

After three months, the groups had the same results on three outcome measures, and those who received the initial diagnosis at home were more likely to adhere to the use of the CPAP treatment.

American College of Physicians

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