Incidence of endstage renal disease in the elderl

Authors: Kosmas I Paraskevas Nikolaos Bessias Sotirios A Koupidis Effie Tziviskou Dimitri P Mikhailidis Dimitrios G Oreopoulos

Publish Date: 2009/12/18

Volume: 42, Issue: 2, Pages: 523-525

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Abstract

With age the glomerular filtration rate and kidney function decline progressively 1 2 Due to the steadily increasing life expectancy around the world and the growing elderly population 3 the incidence of endstage renal disease ESRD among the elderly is rising globally and should be expected to increase tremendously in the next few years/decades 4 According to the 2007 United States Renal Data System USRDS Annual Data Report more than 106000 new individuals began therapy for ESRD in 2005 which was 20 more than in 2004 while the prevalent dialysis population increased to 340000 patients that is 33 more than that in 2004 4 By 2004 there was a total of 1371000 patients worldwide receiving dialysis treatment with the number growing at an annual rate of 7 5 6 According to one forecast the number of new patients with ESRD in the United States was expected to increase to 136166 range 110989–164550 by 2015 7 More importantly ESRD rates are rising most quickly among those persons aged ≥65 4 According to the 2007 USRDS Annual Data Report 4 in 2005 the overall median age of new ESRD patients was 646 years Although the incident rates between 2000 and 2005 have been relatively steady for most age groups for patients ≥75 years the rate has grown by an astonishing 10 that is from 1570 to 1725 patients per 1000000 population 4 According to a more recent report 8 the number of new octogenarians and nonagenarians starting dialysis increased from 7054 persons/year in 1996 to 13577 persons/year in 2003 corresponding to an average annual increase in dialysis initiation of 98 or an increase in the rate of dialysis initiation by 57 between 1996 and 2003 These data clearly underline the importance of the growing epidemic of ESRD particularly among the elderly with its accompanying socioeconomic consequencesA report from the Centers for Disease Control and Prevention showed that 614 of patients hospitalized with kidney disease in 2005 were 65 years old The same incidence was 499 in 1980 9 These data provide another proof of the rising incidence of chronic kidney disease CKD in the elderly An increase of approximately 300 from 193 to 562 per 10000 population occurred among persons aged 65–74 and an increase of approximately 350 from 1190 to 3932 per 10000 population occurred among persons aged 75 9 Kidney disease was the 9th leading cause of death in the United States in 2005 with nearly 26000000 persons having CKD and another 20000000 being at increased risk for CKD 9 ESRD causes approximately 85000 deaths each year in the United States 9Several issues vary between younger and elderly patients The possible vascular access options in elderly patients with ESRD should not be different from younger individuals 10 However access to renal transplantation is limited considerably by increasing age 11 12 Furthermore older patients with CKD often report a worse qualityoflife than younger individuals 13 14 although elderly patients may often adjust to dialysis psychosocially better than younger individuals the losses in physical and cognitive function may challenge the qualityoflife in a large percentage of them 13 14 In addition CKD is associated with an increased risk for cardiovascular complications and cardiovascular disease mortality 15 16 Furthermore with growing age the immune system is influenced in both qualitative and quantitative manner making these patients more susceptible to infection and sepsis 17 Probably as a result of this dialysis does not provide a survival benefit in elderly patients with ESRD and several comorbidities 15 16 All the above issues constitute important parameters when considering the effect of ESRD on economies around the globe Patients with ESRD consume a considerable part of a country’s budget on health apparently this percent is going to increase as the years go by The total annual cost of treating ESRD patients in the United States was estimated to be 33 billion in 2009 9Several solutions to this growing global problem have been proposed such as renal management clinics where preventive measures eg optimal management of diabetes mellitus and hypertension with drugs and lifestyle measures to delay progression of renal failure should be expanded and applied to all patients with CKD stages 3 and 4 18 Also home dialysis 19 and dialysis in nursing homes with extended care facilities 20 offer treatment for elderly patients without family support these alternatives may prove to be better options than inhospital dialysis Another option for frail and physically dependent elderly patients with ESRD may be assisted automated peritoneal dialysis 21 or assisted peritoneal dialysis for the elderly 22 These options utilize the assistance of homecare nurses and family members 21 22 Patients with many comorbidities who cannot perform peritoneal exchange by themselves are offered considerable advantages with automated peritoneal dialysis since this limits homecare nurse visits to only two a day Automated peritoneal dialysis keeps the patient’s daytime free for nursing home activities increases socialization and enables better rehabilitation that improves the qualityoflife of these individuals 22 Some of these may contribute to the reduction in costs for dialysis patients Others may actually increase costs All these suggestions however need to be tested extensively before applying them to an organized health systemAnother important issue that needs to be taken into consideration is the costeffectiveness of the dialysis method A recent analysis of the cost of different dialysis modalities in UK hospitals showed that the most costeffective modalities are continuous ambulatory peritoneal dialysis and automated peritoneal dialysis with mean annual costs of £15570 and £21655 respectively In contrast hospitalbased hemodialysis and satelliteunitbased hemodialysis were not costeffective with mean annual costs of £35023 and £32669 respectively 23 A systematic review of the literature regarding the costeffectiveness of dialysis treatment modalities demonstrated that hemodialysis is indeed a more expensive option than peritoneal dialysis 24In conclusion the incidence of CKD stages 3–5 in the elderly is increasing around the world with every year This increase holds considerable socioeconomic consequences for health economies worldwide Thus it is important to employ measures to reduce mortality rates in this population There is an urgent need for a solution to this new epidemic by governments in collaboration with the Nephrology community around the world before its weight on global economy becomes unbearable

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