PERITONEAL DIALYSIS IN ELDERLY

Abstract

Background:Peritoneal dialysis is used more and more as treatment of substitution of the end stage renal disease at the old subjects of more than 65 years and its effectiveness and its good tolerance were shown.
Aims:To study the epidemiological and clinical profile of these patients, the indication and the advantages of PD, the various complications, the elements of prognostic and the survival of the patients and the technique.
Methods:We made a retrospective study including a series of 13 old patients of more than 65 years and treaties by PD during the period extending from the 1983 /2/ 11 to the 2005/ 12/31. They are 10 men and 3 women on average of 70 ± 3, 1 year and representing 3, 62 % of the totality of the patients. The diabetic and vascular nephropathies represent the first cause of ESRD.
Results:The PD was used of first intention at 53,84 % of the patients whose majority suffers from a malnutrition due to advanced age, anorexia, psychological disorders, bad dental state and uraemia. The cardiovascular complications are frequent in this age bracket explaining heavy morbidity. The pulmonary and urinary infectious complications are also frequent. The more frequent peritonitis compared to the literature, are comparable between the 2 age brackets < and = with 65 years and the mode of PD (APD or CAPD). The time separating the beginning from PD and which has occurred of the peritonitis is shorter in APD. The lesions of renal osteodystrophy are found among 6 patients: 3 cases of hyperparathyroidism and 3 cases of adynamic osteopathy The return in HD is rare due to dysfunction of the catheter.The survival of the patients is 92, 8 % at 1 year and 60, 8 % at 5 years; that of the technique is worse with 88, 3 % at 1 year and 33, 7 % at 5 years  Eight patients died (61, 5 %) because of cardiovascular diseases and of the infections. We found a correlation statistically significant between the survival of the patients and the mode of PD, on the other hand any correlation was not found with the age or the sex. The survival of the technique is not correlated to a significant degree with the age, the sex and the mode of PD.
Conclusion: Peritoneal dialysis is used of first intention at more half of the old subjects and remains a last recourse for haemodialysis which have an initially vascular problem. The family support and the good nurse allow these patients to adhere well to the technique. The cardiovascular diseases and the infections are responsible for heavy morbi-mortality. The survival of the technique is worse than that of the patients.