Health Of Dialysis Patients Research Articles

Comprehensive care for kidney transplantation-optimization of interdisciplinary support before and after kidney transplantation

Due to the divergence between the number of potential organ recipients and organ availability, transplant survival is of particular importance. In order to create the best possible conditions, it is not only important to address the risk factors for loss of organ functionality after transplantation, but also to focus on the time before transplantation. During this period, which lasts several years on average, the patient can create the conditions for risk reduction before and after transplantation with support. The optimization of physical health plays an important role here in order to maintain transplantability, on the one hand, and to counteract the general loss of physical performance due to dialysis, on the other. Therefore, the focus must be placed on "exercise" and "nutrition", which represent an increased risk of declining physical health in dialysis patients. After transplantation, the focus should again be on physical health. Through support, patients learn how to improve their cardiovascular risk profile and increase their physical performance. Psychosocial support is also important to combat psychological comorbidities and prevent risks such as nonadherence. In addition to improved physical and mental health, the focus here is also on the long-term survival of the patient and the transplant.

MO823: Psychological Impact of COVID-19 in Hemodialysis Patients

BACKGROUND AND AIMSThe COVID-19 pandemic has required containment measures in Morocco, as well as practice changes in haemodialysis centres. Haemodialysis patients are at risk of aggressive symptoms of COVID-19, which significantly increases mortality. This particular situation creates psychological disorders in those patients, such as anxiety, sleep disorders and irritability. The objective of our study is to assess the mental health status of haemodialysis patients during the pandemic and the psychological impact of confinement. This assessment will allow the adaptation of a supportive relationship with the patient through adequate psychological management.METHODThis is a mono-centric, non-interventional study that included all haemodialysis patients at the haemodialysis centre of the nephrology department at Ibn Rochd University Hospital during the confinement period (March 2020–June 2020).This study is based on a pseudonymized paper questionnaire, during confinement, based on two psychiatric scores (GAD-7, PHQ-9) that assess anxiety, depression as well as sleep disorders, which allowed us to collect socio-demographic data, anxiety depressive symptomatology and an assessment of sleep disorders.RESULTSThe average age of our population is 47.4 years old, 54% of whom are men. Almost 34.54% have a primary level of education The higher level of education was 14.45%, while 14.54% are illiterate. Regarding family status, 45% are married. Those who are living alone accounted for 55%. Before confinement, 57.15% patients were daily workers; 10 others had no work, among 3 of them were students; the 5 others were managers. After starting haemodialysis, 65.7% patients stopped their work.We noted that 38% of patients had a feeling of nervousness and anxiety for several days, while 9% had the same symptoms for more than half of the day. Concerning excessive anxiety, it was noted in 34% of patients for several days, while 16% showed excessive anxiety for more than half of the days. Concentration difficulties were noted in 41% of the patients for over several days and 5% more than half of days, while 58% of patients never had difficulties of concentration. The irritability feeling over several days was noted in 43% of patients, while 5.4% presented a feeling of irritability more than half of the days. Difficulty falling asleep is noted in 49% of patients, while 51% of patients have no difficulty falling asleep. The feelings of sadness, depression and despair are noted in 49% of patients for several days and 5% for more than half of the days. Sleep disorders were noted in 60% of patients on several days, while 40% had sleep disorders on more than half of the days. Loss of appetite was noted in 65% of patients. A lack of self-confidence was noted for several days in 43% of patients. 29% of patients lost the pleasure of having fun for several days. A total of 36% were slow or restless for several days. None of our patients expressed a desire to end their life, and 49% did not lose the pleasure of doing their daily activity.CONCLUSIONThe mental health of dialysis patients assessed appears to be unaffected during this first wave of the pandemic. This could be due to high resilience, higher unemployment among dialysis patients, a reduced impact of social distancing on the haemodialysis population, strict precautionary measures and perceived support from health workers, who can all contribute to addressing this pandemic.

Impact of Polypharmacy on Health-Related Quality of Life in Dialysis Patients

Introduction: Dialysis patients are often prescribed a large number of medications to improve metabolic control and manage coexisting comorbidities. However, some studies suggest that a large number of medications could also detrimentally affect patients’ health-related quality of life (HRQoL). Therefore, this study aims to provide insight in the association between the number of types of medications and HRQoL in dialysis patients. Methods: A multicentre cohort study was conducted among dialysis patients from Dutch dialysis centres 3 months after initiation of dialysis as part of the ongoing prospective DOMESTICO study. The number of types of medications, defined as the number of concomitantly prescribed types of drugs, was obtained from electronic patient records. Primary outcome was HRQoL measured with the Physical Component Summary (PCS) score and Mental Component Summary (MCS) score (range 0–100) of the Short Form 12. Secondary outcomes were number of symptoms (range 0–30) measured with the Dialysis Symptoms Index and self-rated health (range 0–100) measured with the EuroQol-5D-5L. Data were analysed using linear regression and adjusted for possible confounders, including comorbidity. Analyses for MCS and number of symptoms were performed after categorizing patients in tertiles according to their number of medications because assumptions of linearity were violated for these outcomes. Results: A total of 162 patients were included. Mean age of patients was 58 ± 17 years, 35% were female, and 80% underwent haemodialysis. The mean number of medications was 12.2 ± 4.5. Mean PCS and MCS were 36.6 ± 10.2 and 46.8 ± 10.0, respectively. The mean number of symptoms was 12.3 ± 6.9 and the mean self-rated health 60.1 ± 20.6. In adjusted analyses, PCS was 0.6 point lower for each additional medication (95% confidence interval [95% CI]: −0.9 to –0.2; p = 0.002). MCS was 4.9 point lower (95% CI: −8.8 to –1.0; p = 0.01) and 1.0 point lower (95% CI: −5.1–3.1; p = 0.63) for the highest and middle tertiles of medications, respectively, than for the lowest tertile. Patients in the highest tertile of medications reported 4.1 more symptoms than in the lowest tertile (95% CI: 1.5–6.6; p = 0.002), but no significant difference in the number of symptoms was observed between the middle and lowest tertiles. Self-rated health was 1.5 point lower for each medication (95% CI: −2.2 to –0.7; p < 0.001). Discussion/Conclusion: After adjustment for comorbidity and other confounders, a higher number of medications were associated with a lower PCS, MCS, and self-rated health in dialysis patients and with more symptoms.

MO822POLYPHARMACY NEGATIVELY AFFECTS HEALTH-RELATED QUALITY OF LIFE IN DIALYSIS PATIENTS

Abstract Background and Aims Dialysis patients are often prescribed a large number of medications to improve metabolic control and manage co-existing comorbidities. However, several studies suggest that a large number of medications can also detrimentally affect their health-related quality of life (HRQoL). Therefore, this study aims to provide insight in the association between the number of medications and various aspects of HRQoL in dialysis patients. Method A multicentre study was conducted among dialysis patients from Dutch dialysis centres three months after initiation of dialysis as part of the ongoing prospective DOMESTICO study. The number of medications, defined as the number of concomitantly prescribed types of drugs, was obtained from electronic patient records. Primary outcome was HRQoL measured with the Physical Component Summary (PCS) score and Mental Component Summary (MCS) score (range 0-100) of the Short Form 12. Secondary outcomes were number of symptoms (range 0-30) measured with the Dialysis Symptoms Index and self-rated health (range 0-100) measured with the visual analogue scale of the EuroQol-5D-5L. Data were analysed using linear regression and adjusted for possible confounders, including age, sex, dialysis modality, and comorbidity. Analyses for MCS and number of symptoms were performed after categorising patients in tertiles according to their number of medications because assumptions of linearity were violated for these outcomes. Results A total of 162 patients were included. Mean age of patients was 58 ± 17 years, 35% were female, and 80% underwent haemodialysis. The mean number of medications was 12.2 ± 4.5. Mean PCS and MCS were 36.6 ± 10.2 and 46.8 ± 10.0, respectively. The mean number of symptoms was 12.3 ± 6.9 and mean self-rated health 60.1 ± 20.6. In adjusted analyses, PCS was 0.6 point lower for each additional medication (95%CI -0.9 – -0.2; p=0.002). MCS was 4.9 point lower (95%CI -8.8 – -1.0; p=0.01) and 1.0 point lower (95%CI -5.1 – 3.1; p=0.63) for the highest and middle tertiles of medications, respectively, compared to the lowest tertile. Patients in the highest tertile of medications reported 4.1 more symptoms compared to the lowest tertile (95%CI 1.5 – 6.6; p=0.002) but no significant difference in the number of symptoms was observed between the middle and lowest tertile. Self-rated health was 1.5 point lower for each medication (95%CI -2.2 – -0.7; p&amp;lt;0.001). Conclusion After adjustment for comorbidity and other confounders, a higher number of medications was associated with a lower PCS, MCS, and self-rated health in dialysis patients and with more symptoms. This suggests that it may be relevant to weigh expected therapeutic benefits of medication against their possible harmful effects on HRQoL. An unfavourable balance between expected benefits and impact on HRQoL might be ground to deviate from clinical guidelines, especially for patients with a limited life-expectancy and for whom a kidney transplant is unattainable.

The Impact of COVID-19 on the mental health of dialysis patients

BackgroundStudies have shown increased anxiety, depression, and stress levels among different populations during the coronavirus disease 2019 (COVID-19) pandemic. However, the impact of the pandemic on the mental health of dialysis patients remains unknown. The aim of this study was to investigate the mental health of dialysis patients during the COVID-19 pandemic compared to the period preceding the pandemic.MethodsData originate from the ongoing multicentre observational Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO). Patients who filled in a health-related quality of life (HRQoL) questionnaire during the pandemic and six to three months prior were included. The mean difference in Mental Component Summary (MCS) score of the Short Form 12 (SF-12) was analysed with multilevel linear regression. A McNemar test was used to compare presence of mental health-related symptoms during and prior to the COVID-19 pandemic.ResultsA total of 177 patients were included. The mean MCS score prior to COVID-19 was 48.08 ± 10.15, and 49.00 ± 10.04 during the COVID-19 pandemic. The adjusted mean MCS score was 0.93 point (95% CI − 0.57 to 2.42) higher during the COVID-19 pandemic than during the period prior to the pandemic. Furthermore, no difference in the presence of the following mental health-related symptoms was found during the COVID-19 pandemic: feeling anxious, feeling sad, worrying, feeling nervous, trouble falling asleep, and trouble staying asleep.ConclusionsThe mental health of dialysis patients appears to be unaffected by the COVID-19 pandemic. Dialysis patients may be better able to cope with the pandemic, since they have high resilience and are less impacted by social distancing measures.Trial registration numberNetherlands Trial Register NL6519, date of registration: 22 August 2017.Graphic abstract

Creatinine synthesis rate and muscle strength and self-reported physical health in dialysis patients

Urinary creatinine excretion reflecting endogenous creatinine synthesis rate (CSR) is an established measure of muscle mass in the general populations and in patients with chronic kidney disease. There is increasing data to suggest that CSR not only reflects muscle mass, but also muscle function. In dialysis patients, CSR has rarely been studied since it requires dialysate collection. We aimed to study whether CSR is associated with muscle strength, and self-reported physical health in dialysis patients. Total daily CSR (dialytic removal plus, if applicable, urinary excretion), handgrip strength, and self-reported physical health according subscales of the Checklist Individual Strength and the Short Form-36 were assessed in 50 dialysis patients. Associations of CSR, indexed to body surface area, with handgrip strength and self-reported physical health were studied using multivariable linear regression models. Median age was 69 [interquartile range 60-78] years. Mean CSR was higher in men than in women (9.5±3.3 mmol/24h versus 6.8±1.9 mmol/24h respectively, P=0.007). Age, BMI, and plasma albumin were positively associated with CSR. CSR was positively associated with handgrip strength (adjusted (a-) β: 0.44 [95% CI: 0.18 to 0.71), physical functioning (a-β: 0.54 [95% CI: 0.19 to 0.88]), social functioning (a-β: 0.43 [95%CI 0.08 to 0.76]), and inversely with physical inactivity (adjusted β:-0.69 [95% CI:-1.00 to-0.38), fatigue (adjusted β:-0.61 [95% CI:-0.93 to-0.27]), and role limitation due to physical health (a-β: 0.39 [95% CI: 0.04 to 0.74]). In dialysis patients, a greater CSR is associated with higher muscle strength, better physical and social functioning, and physical activity, and with less fatigue, and role limitation due to physical health. Thus, CSR reflects muscle function, self-reported physical health and social functioning in dialysis patients.

Strong Associations Between Inflammation, Pruritus and Mental Health in Dialysis Patients.

Pruritus, impaired mental health and inflammation contribute to morbidity in end-stage renal disease. There are no studies on all 3 conditions. We therefore obtained inflammatory parameter data (C-reactive protein and interleukin-6), pruritus data and psychological test data (36-Item Short-Form Health Survey, "Allgemeine Depressionsskala" and Toronto Alexithymia Scale-20) for 19 dialysis patients with pruritus, 20 dialysis patients without pruritus and 15 healthy controls. Non-parametric hierarchical clustering revealed 3 clusters of parameters: one mainly driven by pruritus scores (chronic kidney disease-associated pruritus cluster), one by mental health scores (mental health cluster) and one by inflammatory parameters (inflammatory cluster). Factor analysis showed strong associations (mental health cluster/chronic kidney disease-associated pruritus cluster, r=-0.49; mental health cluster/inflammatory cluster, r=-0.52; inflammatory cluster/chronic kidney disease-associated pruritus cluster, r=0.48). For the first time, complete correlations between inflammation, mental health and pruritus in dialysis patients have been established. As all 3 conditions are associated with mortality, knowledge about their interdependence helps to understand end-stage renal disease pathophysiology.

Peculiarity of Postoperative Period in Hemodialysis Patients after Parathyroidectomy

Signs of hypocalcemia of varying degrees of intensity are often shown in hemodialysis patients after parathyroidectomy for severe hyperparathyroidism on the background of the “hungry bone” syndrome. Teaching of patients to distinguish early clinical signs of hypocalcemia and to inform the medical staff about them in time and regular monitoring of ionized calcium with a personalized approach to introduction of calcium preparations in parenteral and oral form promote the favorable course of the postoperative period and help to avoid severe complications. Significant reduction of bone pain syndrome and improvement of general health in dialysis patients are noted in the early postoperative period.

Religious involvement and health in dialysis patients in Saudi Arabia.

Patients on hemodialysis experience considerable psychological and physical stress due to the changes brought on by chronic kidney disease. Religion is often turned to in order to cope with illness and may buffer some of these stresses associated with illness. We describe here the religious activities of dialysis patients in Saudi Arabia and determined demographic, psychosocial, and physical health correlates. We administered an in-person questionnaire to 310 dialysis patients (99.4 % Muslim) in Jeddah, Saudi Arabia, that included the Muslim Religiosity Scale, Structured Clinical Interview for Depression, Hamilton Depression Rating Scale, Global Assessment of Functioning scale, and other established measures of psychosocial and physical health. Bivariate and multivariate analyses identified characteristics of patients who were more religiously involved. Religious practices and intrinsic religious beliefs were widespread. Religious involvement was more common among those who were older, better educated, had higher incomes, and were married. Overall psychological functioning was better and social support higher among those who were more religious. The religious also had better physical functioning, better cognitive functioning, and were less likely to smoke, despite having more severe overall illness and being on dialysis for longer than less religious patients. Religious involvement is correlated with better overall psychological functioning, greater social support, better physical and cognitive functioning, better health behavior, and longer duration of dialysis. Whether religion leads to or is a result of better mental and physical health will need to be determined by future longitudinal studies and clinical trials.

Quality of Life and Mental Health Related to Timing, Frequency and Dose of Hemodialysis

The perceived quality of life (QOL) and mental health of dialysis patients can have a significant impact on clinical outcomes in the end-stage renal disease (ESRD) population. There is growing interest in increasing dialysis frequency, dose and duration to achieve more adequate dialysis clearance, particularly of middle molecules. Over the past decade, there has been an interest in earlier initiation of dialysis; however, the results of the IDEAL study call this practice into question, and showed no difference in QOL scores between the early-start and later start dialysis patients. There are inconsistent results regarding the impact of increased dialysis frequency and dose on patients' perceived health-related QOL (HRQOL). Some studies of daily nocturnal dialysis patients show a positive impact on QOL, while others show no significant difference. The disparate outcomes may be partly related to differences in the demographic characteristics of the study populations and the specific questionnaires used to measure HRQOL. Additional research is necessary to determine whether changes in dialysis frequency, timing, and dose can positively or negatively impact patients' perceptions of their QOL and mental health.

The Health of Dialysis Patients is in Our Hands

The Health of Dialysis Patients is in Our Hands

Oral disease in adults treated with hemodialysis: prevalence, predictors, and association with mortality and adverse cardiovascular events: the rationale and design of the ORAL Diseases in hemodialysis (ORAL-D) study, a prospective, multinational, longitudinal, observational, cohort study.

BackgroundPeople with end-stage kidney disease treated with dialysis experience high rates of premature death that are at least 30-fold that of the general population, and have markedly impaired quality of life. Despite this, interventions that lower risk factors for mortality (including antiplatelet agents, epoetins, lipid lowering, vitamin D compounds, or dialysis dose) have not been shown to improve clinical outcomes for this population. Although mortality outcomes may be improving overall, additional modifiable determinants of health in people treated with dialysis need to be identified and evaluated.Oral disease is highly prevalent in the general population and represents a potential and preventable cause of poor health in dialysis patients. Oral disease may be increased in patients treated with dialysis due to their lower uptake of public dental services, as well as increased malnutrition and inflammation, although available exploratory data are limited by small sample sizes and few studies evaluating links between oral health and clinical outcomes for this group, including mortality and cardiovascular disease. Recent data suggest periodontitis may be associated with mortality in dialysis patients and well-designed, larger studies are now required.Methods/designThe ORAL Diseases in hemodialysis (ORAL-D) study is a multinational, prospective (minimum follow-up 12 months) study. Participants comprise consecutive adults treated with long-term in-center hemodialysis. Between July 2010 and February 2012, we recruited 4500 dialysis patients from randomly selected outpatient dialysis clinics in Europe within a collaborative network of dialysis clinics administered by a dialysis provider, Diaverum, in Europe (France, Hungary, Italy, Poland, Portugal, and Spain) and South America (Argentina). At baseline, dental surgeons with training in periodontology systematically assessed the prevalence and characteristics of oral disease (dental, periodontal, mucosal, and salivary) in all participants. Oral hygiene habits and thirst were evaluated using self-administered questionnaires. Data for hospitalizations and mortality (total and cause-specific) according to baseline oral health status will be collected once a year until 2022.DiscussionThis large study will estimate the prevalence, characteristics and correlations of oral disease and clinical outcomes (mortality and hospitalization) in adults treated with dialysis. We will further evaluate any association between periodontitis and risk of premature death in dialysis patients that has been suggested by existing research. The results from this study should provide powerful new data to guide strategies for future interventional studies for preventative and curative oral disease strategies in adults who have end-stage kidney disease.

P15. Effects of hemodialysis on the nitric oxide congeners nitrite and nitrate: Implications for cardiovascular health in dialysis patients

P15. Effects of hemodialysis on the nitric oxide congeners nitrite and nitrate: Implications for cardiovascular health in dialysis patients

Hemodialysis and oral health

Aims of study: The purposes of this study were to evaluate the oral health, the educational level and decay frequency in hemodialysis patients. Materials and Methods: This study was conducted on 100 patients, 43 of them were controlled patients admitted to the general dental unit in Al-Salam Hospital, while the remaining 57 patients underwent hemodialysis in the Dialysis Unit in Ibn-Sina Hospital in Mosul. Special consent form for each patient was obtained along with a noninvasive oral examination. Results: By using SPSS, significant pvalue was detected between education level & disease, the visit to dentist & disease. ANOVA test was done for study groups & gingival index, plaque index showed significant relation. For decayed teeth, significant pvalue was observed. Conclusion: Present study results confirm the hypothesis that periodontal disease prevalence exists in hemodialysis patients, so regular dental visits are needed to ensure optimal oral health in dialysis patients. Education of hemodialysis patients for their oral health and bilateral motivation between medical staff and dentists is mandatory.

Espiritualidade no paciente em diálise: o nefrologista deve abordar?

Studies on the relationship between spirituality and health are increasingly common in the international literature, showing the association of spirituality with lower levels of depression and anxiety, better quality of life, and lower hospitalization and mortality rates. To evaluate the relationship between spirituality/religiosity and health in dialysis patients. A literature review was conducted through search in the Scielo, LILACS, Medline, and PsycIN-FO data banks. Articles addressing the association between spirituality/religiosity and health in dialysis patients were selected. Higher levels of spirituality and religiosity were associated with better quality of life, less depression, greater social support, higher satisfaction with life, and more satisfaction with the nephrologist';s treatment. Similarly, less spiritualized dialysis patients asked more often for supportive therapy, such as orotracheal intubation. Spirituality was a coping factor for the families of dialysis patients. The literature showed no relationship between spirituality and quality of sleep, compliance with treatment, and mortality. Spirituality and religiosity play an important role for dialysis patients. They are associated with important aspects of the physician-patient relationship, quality of life, and coping. Thus, they should be valued by professionals caring for those patients.

Hypercalcaemia is associated with poor mental health in haemodialysis patients: results from Japan DOPPS

The Dialysis Outcomes and Practice Patterns Study (DOPPS) reported high incidence of depression in haemodialysis patients. Hypercalcaemia and high parathyroid hormone (PTH) levels are aetiological factors of psychological disorders. We examined the association between mineral metabolism abnormalities and mental health in Japanese-DOPPS patients. We used baseline data of Japan-DOPPS, Phase 1 (2755 patients, 1999-2001) and Phase 2 (2286 patients, 2002-03). The outcome variable was mental health using the mental health domain of SF-36. We examined the association between serum corrected calcium, phosphorus, calcium x phosphorus product and intact PTH concentrations, and mental health using analysis of covariance and also the associations between corrected calcium levels and current use of vitamin D and calcium-containing phosphate binder. There was a significant association between mental health and corrected calcium levels. A significantly lower mental health score was noted in patients with corrected calcium > or = 11 mg/dl than in <8.4 (P = 0.04), > or =8.4 to <10.2 (P = 0.009) and > or =10.2 to <11 mg/dl (P = 0.003). The association was significant even after adjustment for age, sex and other confounders. However, there was no relationship between intact PTH and mental health. High-corrected calcium levels were significantly associated with the use of intravenous active vitamin D and calcium-containing phosphate binder. Hypercalcaemia, but not high intact PTH, is associated with poor mental health in dialysis patients. While a cause-effect relationship between hypercalcaemia and deterioration of mental health needs further confirmation by longitudinal and prospective studies, our observational findings suggest the importance of control of serum calcium concentration in dialysis patients.

Physical functioning in end‐stage renal disease patients: Update 2005

Physical functioning in patients with end-stage renal disease treated with dialysis is low, whether measured using objective laboratory measures, physical performance testing, or self-reported measures. Peak oxygen uptake (VO2peak), self-reported functioning measures, and physical activity levels are independent predictors of mortality in these patients. Cardiovascular exercise training studies result in improvements in VO2peak, physical performance tests, and self-reported functioning. Resistance exercise training improves muscle strength. Exercise training may have positive benefits on other factors that are important clinical issues in dialysis patients, including cardiovascular risk profile, oxidative stress, and inflammation. Endothelial function, a surrogate marker of atherosclerosis, has been shown to improve with exercise training in dialysis patients. Although there have been numerous recent studies on benefits of exercise, few dialysis clinics or nephrologists provide encouragement or programs as a part of their routine care of their patients. There are many national guidelines that include exercise or increasing physical activity as a part of the treatment of many conditions that are relevant in dialysis patients, including hypertension, hyperlipidemia, and high cardiovascular disease risk. The nephrology community continues to state concern for outcomes; however, a simple, low-tech intervention that has many benefits to their patients (i.e., encouragement, recommendations, and opportunity for increasing physical activity) has not been adopted as part of the standard care. Adoption of routine counseling and encouragement for physical activity has the potential to improve outcomes, improve physical functioning, and optimize quality of life and overall health of dialysis patients.

PUR1: HEALTH STATUS OF ELDERLY DIALYSIS PATIENTS

OBJECTIVES: The elderly comprise approximately half of new patients undergoing dialysis, an expensive, lifesaving treatment. We report the health status of 3 elderly age groups, including novel information about patients 85 years, hypothesizing that as age increases health status will decrease. METHODS: This retrospective analysis reports on 6154 patients treated by one dialysis chain (48.4% male, 61.5% white, 39.1% diabetes as primary diagnosis). Health status is reported by a single administration of the SF-36 between 10/30/90 and 10/30/00. RESULTS: Although not statistically significant at p < .01, with increasing age, there are trends to lower Physical Function and Role Physical scores. The Physical Component Score shows a statistically significant difference between groups 1 and 2. Group 3, the very elderly, are not significantly different from groups 1 or 2. Other scales show no change. CONCLUSIONS: As hypothesized, physical health of dialysis patients appears vulnerable to age. However, other domains of health status remain robust. The very elderly receiving dialysis maintain their mental health when compared to patients in the 2 younger age groups. (See table below.) Table for PUR1 Mean SF-36 SCORE (SD) 1652 1 Physical Function Role Physical Bodily Pain General Health Vitality Social Function Role Emotional Mental Health Physical Component Score* Mental Component Score * = p < .01 Group 1 65–74 36.9 (27.8) n = 3687 29.3 (37.9) n = 3609 58.5 (29.0) n = 3674 43.2 (20.1) n = 3587 42.7 (22.8) n = 3635 62.8 (28.8) n = 3687 55.7 (43.6) n = 3577 69.2 (20.0) n = 3621 31.8 (10.1) n = 3445 48.3 (11.3) n = 3445 Group 2 75–84 32.4 (26.2) n = 2117 26.8 (36.4) n = 2059 58.1 (28.4) n = 2111 44.2 (20.0) n = 2073 40.8 (22.4) n = 2098 61.3 (30.0) n = 2119 54.2 (43.9) n = 2038 69.5 (20.1) n = 2089 30.9 (9.4) n = 1957 48.4 (11.6) n = 1957 Group 3 85 30.0 (27.1) n = 267 26.8 (37.5) n = 257 58.7 (58.7) n = 266 46.8 (21.1) n = 254 42.1 (23.0) n = 261 63.5 (30.1) n = 267 53.6 (44.5) n = 257 71.5 (19.1) n = 258 30.7 (10.0) n = 244 49.5 (11.0) n = 244