Dialysis in the Aged
CLINICAL judgment often interdicts hemodialysis in a patient more than 60 years of age even though the clinical condition might be greatly improved for some time by this procedure. In our experience, hemodialysis has proved to be of considerable benefit in this age group if the renal lesion itself is not accompanied by a fatal condition elsewhere in the body. This report describes the results of dialysis in 41 patients 60 years of age or older who were treated during the three-year period of January 1, 1957 through December 31, 1959.
The over-all management of these patients, in addition to hemodialysis, included control of fluid and electrolyte balance, close medical observation, and administration of drugs.
According to the type of renal insufficiency, these patients were divided into two groups, acute uremia and chronic uremia (Table 1). Each of these was then divided into two subgroups designated survival and death. For the purpose of this study, survival in acute renal failure indicates return of adequate renal function; survival in chronic renal failure indicates improvement sufficient to sustain life for two months after the first dialysis. Also, for this analysis we have divided the group of patients who died, into two subgroups designated as potentially recoverable and irrecoverable. We have considered renal insufficiency as an irrecoverable condition only when it accompanied an incurable and fatal illness such as ruptured aortic aneurysm, major cerebrovascular accident, carcinoma, fatal myocardial infarction, massive pulmonary embolism, or severe pulmonary insufficiency due to overwhelming acute bronchopneumonia. The basis . . .