Abstract
Before 1980 few patients over the age of 65 started chronic dialysis, despite the fact that the incidence of advanced chronic renal failure was approximately ten times greater in this group compared to young and middle aged adults.1 Since that time the number of elderly patients starting renal replacement has increased markedly and accounted for 38% of new dialysis patients in Scotland in 1995. (Data supplied by the Scottish Renal Registry). In order to meet the needs of older patients with chronic renal failure there has been considerable expansion in renal services and it has been predicted that this will continue to increase in Scotland until 2010.2
The number of older patients receiving dialysis and transplantation is rising steadily and will continue to rise in the future. There is nowadays no justification for a rigid upper age limit in the selection of patients for dialysis although inevitably more elderly patients will be unsuitable on medical grounds than in the younger age groups in particular due to cardiovascular disease. The majority of elderly patients are best managed by haemodialysis but a considerable number can achieve a reasonable quality of health on peritoneal dialysis. Renal transplantation should be seriously considered in the older patient provided that comorbidity is not present, usually in the form of cardiovascular disease, to a degree which would seriously limit life expectation.
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