SUN-286 HEMODIALYSIS IN EDERLY PATIENTS

Abstract

When dialysis was a scarce resource worldwide, patients of advanced age were often excluded. However, this has changed dramatically. Haemodialysis (HD) of elderly patients has become routine. As a consequence of the aging of the dialysis population, new issues have emerged. HD in elderly and very elderly patients has important differences from younger patients, and an understanding of these issues is critical in effectively guiding their care. Until recently, many studies used a cut-off of 65-year-old (or even younger) as a definition of elderly, grouping all patients over that age. We choose in our study to select patients above 60-year-old as elderly patients. We collected data of patients over 60-year-old who underwent dialysis in our dialysis centre for a period of three months. Our data collection items contain patient identity, his personal medical information, the clinical exam before dialysis, laboratory test before dialysis and evolution during dialysis and after. We used the dialysis registry in the nephrology unit to gather data. Patients who underwent few sessions of dialysis less than 3 months in the dialysis unit were excluded. Patients discharged from hospitalization to their dialysis unit with a normal follow up were included. Our primary end point in this cohort is three months’ survival of the patients. Secondary end points were characteristics of this group, dialysis tolerance and dialysis withdrawal. We use IBM Statistics SPSS v.21 to analyse our data. Our cohort collected data of fifty patients who underwent dialysis in our centre who were above 60 years of age. The gender ratio was 28/22 (56%/44%) (male vs female). The age repartition is as following: 52% are between 60 and 69 year old, 38% between 70 and 79 year old, 8% between 80 and 89 year old and 2% (one patient) above 90 years of age (diagram 1). The most of our patients came from three main units: emergency unit and intensive care unit (ICU) and resuscitation unit with respectively 34%, 10% and 10% (table 1) of the patients hospitalized in these units. Another important part of our patients (12%) are coming from home for their dialysis; these patients moved to the Marrakech for any reasons, or have recently settled down. The Charleson comorbidity score (CCS) was evaluated in our cohort. We found that most of our patients had a CCS 5 or 6 respectively 36% and 34% (table 2). Other clinical and biological exams are summarized in the table 3Tabled 1Clinical dataBiological examsMean (min - max)Hypertension60%Urea (g/l)2.7 (0.5 - 5)Diabetes2% (T1), 50% (T2)Creatinine (mg/l)108 (15 - 231)Cardiac disease46%Calcium (mg/l)76.3 (46 - 98)Anemia72%Phosphorus (mg/l)83.2 (47 - 139)Oedema36%CRP (mg/l)139 (6 - 519)Dehydration12%Haemoglobin (g/dl)8.9 (3.5 – 14.5)Diuresis32% (anuric) 28% (Oliguric)Potassium (mmol/l)5.3 (2.9 – 8.2)Pulmonary crackles26%Sodium (mEq/l)135 (122 - 163)Bicarbonates (mmol/l)12 (5 - 23) Open table in a new tab The mortality rate in our cohort was under the rate described in other cohorts. Most of our patients are from emergency units and the CVVH would be suitable for such patients. Unfortunately they can't because it's not available.