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    Rev Electron Biomed / Electron J Biomed 2010;1:3-5

    Editorial:

    PERITONEAL DIALYSIS IN THE ELDERLY: GENERAL ASPECTS

    Carlos G. Musso1
    Dimitrios G. Oreopoulos2

    1Nephrology Division. Hospital Italiano de Buenos Aires. Argentina
    2Nephrology Division. Toronto Western Hospital. Canada

    carlos.musso @ hospitalitaliano.org.ar


    Version española

    Peritoneal dialysis offers several advantages for old patients: good control of hypertension, independence from hospitals, simplicity of dialytic access, better cardiovascular stability, while its main disadvantages could be impossibility of learning the technique, patient isolation, and family burn-out. There is many controversies regarding if peritonitis, exit-site infection rate, and mortality are significant different between the age groups. However, it is clear that catheter failure is more frequent in younger patients, and there is no significant differences in quality of life between peritoneal dialysis and hemodialysis between old patients.


    Advantages and Disadvantages
    Peritoneal dialysis offers several advantages for old patients such as good control of hypertension, independence from hospitals, simplicity of dialytic access, better cardiovascular stability (less episodes of hypotension or arrhythmias), and the possibility that a family member may perform this procedure, avoiding patient transportation to the hospital. However, it must be taken into account that some elderly patients could not be able to learn the peritoneal dialysis technique, this modality could worsen patient´s social isolation, or burning out the person who perform patient´s dialysis. Moreover, constipation and chronic diverticulosis, prevalent disorders in the elderly, may complicate the clinical course of older patients in peritoneal dialysis.


    Infectious Complications
    Peritonitis and exit-site infection are the most common complications of peritoneal dialysis treatment, and even though the elderly has an increased risk of infection (immune senescence), a broad spectrum of results were documented, ranging from those who did not find any significant difference in peritonitis rate between young and old patients, to those who found peritonitis to be more frequent in the aged people. But bedridden old patients tend to have a higher peritonitis rate.

    Causative micro organism are similar to young patients, but there is some reports that have described a higher incidence of Staphylococcus epidermidis (perhaps explained by a diminished manual dexterity), or Gram negative peritonitis (perhaps explained by gastrointestinal pathology: constipation, diverticulosis, bowel perforation, etc).

    Exit-site infections is less frequent in the elderly than in younger patients on peritoneal dialysis, perhaps because the former are less active than the latter. Additionally, it was documented that catheter failure is more frequent in younger patients (24%) compared to patients older than 60 years (16%).


    Not Infectious Complications
    Malnutrition can be found in 20% of elderly peritoneal dialysis patients and 2% of young ones, being low dietary protein intake a key factor for the poor outcome of dialysis in old people. Blood cholesterol are usually significantly higher in elderly patients on peritoneal dialysis compared to those on hemodialysis, while there is no significant differences in triglyceride levels between the patients on these two modalities.


    Quality of life and Survival
    Quality of life (measured in SF-36 scale) differences between elderly on dialysis and old persons without renal failure were less marked than comparable differences between young patients on dialysis and not. Adjusted analysis also showed no significant differences in quality of life between peritoneal dialysis and hemodialysis patients. Some studies have shown better survival on peritoneal dialysis compared with hemodialysis, others equal, or even worse on hemodialysis.


    Conclusion: Peritoneal dialysis is a good alternative for treating end-stage renal disease patients.



    REFERENCES

      1.- Dimkovic N, Oreopoulos D. Substitutive treatments of end-stage renal diseases in the elderly: dialysis. In Macías Núñez JF, Cameron S, Oreopoulos D (Eds). The ageing kidney in health and disease. New York. Springer. 2008: 443-463

      2.- Grapsa E, Oreopoulos D. Chronic peritoneal dialysis in the elderly. In Khanna R, Krediet R (Eds). Textbook of Peritoneal Dialysis. Springer. 2009: 737-755

      3.- Dimkovic N, Prakash S, Roscoe J, Brissenden J, Tam P, BargmanJ, Vas I, Oreopoulos D. Chronic peritoneal dialysis in octogenarians. Nephrol Dial Transplant. 2001; 16: 2034-2040