Optimizing Renal Replacement Therapy in Older Adults

A Framework for Making Individualized Decisions

Manjula Kurella Tamura; Jane C Tan; Ann M O'Hare

Disclosures

Kidney Int. 2012;82(3):261-269. 

In This Article

Life Expectancy After Dialysis Initiation Among Older Patients

Life expectancy after the start of dialysis for the 25th, 50th and 75th percentile of patients aged 65 and older in the United States is presented in Figure 1. Median life expectancy declines with age, from 2.5 years for 65–69 year olds, to 0.6 years for patients ≥90 years. Among patients of similar ages, there is considerable heterogeneity, including among the very elderly. For example, life expectancy of an 80-year-old patient with ESRD at the 75th percentile (3.0 years) is more similar to the life expectancy of a 70-year-old patient also at the 75th percentile (4.3 years) than it is to the life expectancy of an 80-year-old patient at the 25th percentile (0.4 years).

Figure 1.

Quartiles of life expectancy after dialysis initiation by age group.

Clinical characteristics may help clinicians estimate a patient's life expectancy after dialysis initiation. For example, Moss et al.[6] described the utility of the surprise question ('Would I be surprised if this patient died in the next year?') for predicting short-term mortality. Validated prognostic models may also be used to estimate life expectancy among dialysis patients.[7–10] Most focus on short-term mortality risk,[8,9] although some are also useful for predicting long-term mortality risk.[10] Several are simple enough to adapt to practice.[8,10] Perfectly accurate predictions of life expectancy are not necessary to use this framework. Rather, reasonable estimates of whether a patient is above or below the median life expectancy for his or her age will allow clinicians to make better assessments of the risks and benefits of various management strategies.

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