Chronic Dialysis in the Elderly: Intermittent Peritoneal Dialysis or Hemodialysis?

1983 ◽  
Vol 3 (4) ◽  
pp. 183-186 ◽  
Author(s):  
Abdul Marai Mauro Rathaus Yair Gibor ◽  
Jacques Bernheim
Keyword(s):  
Diabetes Mellitus ◽  
Elderly Patients ◽  
Causes Of Death ◽  
The Elderly ◽  
Long Term Results ◽  
First Year ◽  
Laboratory Parameters ◽  
Risk Patients ◽  
Group Survival

This study compared two groups of elderly patients -16 treated with IPD, and 31 treated with hemodialysis -HD. Predialysis conditions were assessed by means of a scoring system and the results were studied in terms of survival, causes of death, complications and laboratory parameters. In the IPD group, survival was similar to the hemodialysis groups during the first 15 months but declined thereafter. IPD patients also required longer periods of hospitalizations. The causes of death were quite different: mainly cardiovascular in HD, and mainly related to peritonitis in IPD. Laboratory parameters were similar. Analysis of the scoring results showed that the patients selected for IPD had more cardiovascular disease and diabetes mellitus. In conclusion, the results of IPD in elderly patients are comparable to those of HD in the first year. The choice of “poor risk” patients for IPD may explain, in part, the inferior long-term results with this technique.

Validation of hepatectomy for elderly patients with hepatocellular carcinoma.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 380-380
Author(s):  
Norihiro Kishida ◽  
Taizo Hibi ◽  
Osamu Itano ◽  
Masahiro Shinoda ◽  
Minoru Kitago ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Tumor Size ◽  
The Elderly ◽  
Alpha Fetoprotein ◽  
Long Term Results ◽  
Elderly Cohort ◽  
Disease Free

380 Background: Hepatectomy for hepatocellular carcinoma (HCC) and its outcomes in the elderly population have yet to be defined. We aimed to validate our current strategy to determine surgical indication regardless of age. Methods: A single-center, retrospective cohort study was conducted for 104 patients who underwent hepatectomy for HCC from 2005 to 2010. The patients were divided into 2 groups according to age; i.e. <75 years (non-elderly cohort; n=82) and ≥75 years (elderly cohort; n=22), and short-/long-term results were compared. Results: In the elderly cohort, the prevalence of ECOG performance status 1 preoperatively (p<0.001) and HCV or non-HBV/non-HCV were higher than in the non-elderly cohort (p=0.04). Otherwise, patient/tumor characteristics were comparable between the 2 groups. The elderly cohort suffered postoperative complications more frequently (42% vs. non-elderly, 16%, p=0.01) but the length of hospital stay was equivalent. Ninety-day mortality occurred in 1 case each (elderly, respiratory failure; non-elderly, liver failure; p=0.38). During a median follow-up period of 47 months, unadjusted 5-year disease-free and overall survivals were comparable per log-rank comparison (elderly, 25% and 80% vs. non-elderly, 33% and 79%, p=0.96 and 1.00, respectively). Cox univariate analyses on recurrent HCC showed hypertension, Child-Pugh grade B, tumor size, recurrent/multiple tumors, preoperative alpha-fetoprotein level, moderate/poor differentiation, portal invasion, intrahepatic metastases, and positive margins to have p values <0.20. After adjustment, the hazard ratio of recurrent HCC at 5 years in the elderly cohort was 0.87 (95% CI, 0.40-1.91; p=0.74). Tumor size, alpha-fetoprotein level, and intrahepatic metastases emerged as independent predictors of diminished 5-year disease-free survival in the entire cohort. Conclusions: Although postoperative complications develop more frequently, hepatectomy in the elderly patients affords comparable short- and long-term prognoses to the non-elderly patients. Surgical strategy for HCC should be based on tumor factors and hepatic reserve and not by age alone. Perioperative management needs to be individualized according to coexisting disorders.

Functional Outcomes and Quality of Life in Elderly Patients after Restorative Proctocolectomy for Ulcerative Colitis

Digestion ◽  
2019 ◽  
Vol 101 (6) ◽  
pp. 737-742 ◽  
Author(s):  
Tomohiro Minagawa ◽  
Hiroki Ikeuchi ◽  
Ryuichi Kuwahara ◽  
Yuki Horio ◽  
Hirofumi Sasaki ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ulcerative Colitis ◽  
Elderly Patients ◽  
Functional Outcomes ◽  
The Elderly ◽  
First Year ◽  
Significant Difference ◽  
Fecal Soiling

<b><i>Background/Aim:</i></b> Ileal pouch anal anastomosis (IPAA) has become the surgical procedure of choice for patients with ulcerative colitis (UC). However, to date few studies have examined functional outcomes or quality of life (QOL) in elderly patients after pouch construction. <b><i>Methods:</i></b> In December 2017, we sent questionnaires to 224 patients aged 65 years and older at the time who underwent an IPAA at our hospital between June 1987 and May 2015 regarding issues related to QOL and functional outcomes. Responders aged 65–69 years old were defined as the elderly group (EG), while those 70 years old and over comprised the super-EG (SEG). <b><i>Results:</i></b> The response rate was 60.7% (136/224); 70 patients were classified as EG, and 66 were classified as SEG. The SEG were older at the time of the IPAA and during the follow-up period (<i>p</i> &#x3c; 0.01). The stool frequency per day was 8 times in both groups (<i>p</i> = 0.21). There was no significant difference between the EG and SEG with regard to daytime (53 vs. 56%, <i>p</i> = 0.73) or nighttime (65.7 vs. 53%, <i>p</i> = 0.16) soiling. There was also no difference in the exacerbation of daytime or nighttime soiling compared to the first year after the operation (daytime 5.7 vs. 12.1%, <i>p</i> = 0.23; nighttime 7.1 vs. 9.1%, <i>p</i> = 0.76). QOL was evaluated using the modified fecal incontinence QOL (mFIQL) scale, with no significant difference between the EG and SEG (27 vs. 31 points). Since both groups had mFIQL scores &#x3c;50, QOL was considered to be maintained. <b><i>Conclusion:</i></b> In our analysis of elderly patients in the long-term period following surgery for UC, some noted fecal soiling, though QOL was largely maintained, and there were no serious effects on daily life.

scholarly journals MO964DEATH WITH GRAFT FUNCTION AMONG EGYPTIAN KIDNEY TRANSPLANT RECIPIENTS: A SINGLE CENTER EXPERIENCE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Mostafa Gamal ◽  
Ahmed Mohamed Salah ◽  
Yasser Hendy ◽  
Ayman Refaie
Keyword(s):  
Diabetes Mellitus ◽  
Causes Of Death ◽  
Graft Loss ◽  
Graft Function ◽  
First Year ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Serious Infections

Abstract Background and Aims Kidney transplantation is the optimal treatment of end stage renal disease (ESRD). Despite improvements in patient selection and management, every transplant carries risk of graft loss. Death with graft function (DWGF) is an important cause of long-term loss of grafts and patients. In this study, we investigated clinical characteristics and causes of DWGF among a cohort of 2953 Egyptian kidney transplant recipients. Method A total of 291 recipients who died with graft function (DWGF) were evaluated regarding causes and timing of death. Causes of death were investigated in different eras of immunosuppression; era 1 (1976-1995): steroid and azathioprine, era 2 (1996-2005): cyclosporine-based and era 3 (2006-2018): tacrolimus-based. Demographic data, original kidney disease, pre- and post-transplant co-morbidities, immunosuppression regimens, biopsy proven acute rejection episodes and graft function at last follow up were analyzed. Results Proportion of DWGF in total graft loss had changed over time. In our retrospective study, it decreases from 29.5% in era 1 to 13.7% in the most recent era of kidney transplantation. Most patients in DWGF group had diabetes mellitus, hypertension, frequently experienced more infections and more rejection episodes. cyclosporine-based immunosuppression was more prevalent. A total of 291 patients (9.9%) died with graft function. DWGF was responsible for 58.3% of a total of 499 deaths (figure 1). For this group of patients, median serum creatinine at last follow up was 1.7 mg/dl (range: 0.2 - 7 mg/dl). Out of 291 recipients who died with functioning graft, 53 patients (18.2%) died within the first year, 55 (18.9%) died within 1-5 years, 75 (25.8%) died within 5-10 years while 108 patients (37.1%) died after 10 years post transplantation. The majority of DWGF was secondary to cardio-vascular diseases (CVD) (30.9%) and serious infections (29.2%) (figure 2). Death due to malignancy was lowest within the first year (1.9%), increased thereafter but unexpectedly malignancy (22.2%) was the third main cause of death in the late period after transplantation (figure 3). Conclusion DWGF accounts for 24.5% of total graft loss. The most common cause is cardiovascular disease followed by serious infections. Pre-transplant diabetes mellitus, steroid dose and infections had most significant association with DWGF. Understanding different causes of death according to the time after transplantation is mandatory in order to improve the long-term outcomes.

scholarly journals Chronic dialysis in patients over age 65.

1996 ◽  
Vol 7 (5) ◽  
pp. 637-646
Author(s):  
D L Latos
Keyword(s):  
Elderly Patients ◽  
The Elderly ◽  
The United States ◽  
Cardiovascular Complications ◽  
Treatment Modalities ◽  
Additional Time ◽  
Access Problems ◽  
Suitable Treatment ◽  
Group Survival

In the United States, persons over the age of 65 are expected soon to become the majority of those people who will require maintenance dialysis therapy. Many of these individuals have numerous comorbid medical complications, which, together with altered physiologic adaptation related to aging, create a great challenge for the nephrologist. Despite a considerably lower group survival rate and increased hospitalization utilization as compared with younger patients, many elderly dialysis patients tolerate therapy very well and appear quite satisfied with the quality of their lives. Both hemodialysis and peritoneal dialysis are suitable treatment modalities for elderly patients, but recommendations regarding type of dialysis must be individualized, taking both medical and psychosocial issues into consideration. Vascular access problems are particularly important for the elderly and contribute to significant morbidity. Malnutrition and cardiovascular complications also require special attention. Withdrawal from dialysis appears to be increasingly common among elderly ESRD patients and highlights the need for the completion of advance directives. A trial of dialysis may allow elderly patients and their families additional time to decide whether long-term dialysis is deemed appropriate.

Surgical reconstruction for unilateral iliac artery lesions in patients younger than 50 years

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 474-481 ◽  
Author(s):  
Radak ◽  
Babic ◽  
Ilijevski ◽  
Jocic ◽  
Aleksic ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Limb Salvage ◽  
Iliac Artery ◽  
Graft Patency ◽  
Long Term Results ◽  
Surgical Reconstruction ◽  
Safe Procedure ◽  
Term Survival

Background: To evaluate safety, short and long-term graft patency, clinical success rates, and factors associated with patency, limb salvage and mortality after surgical reconstruction in patients younger than 50 years of age who had undergone unilateral iliac artery bypass surgery. Patients and methods: From January 2000 to January 2010, 65 consecutive reconstructive vascular operations were performed in 22 women and 43 men of age < 50 years with unilateral iliac atherosclerotic lesions and claudication or chronic limb ischemia. All patients were followed at 1, 3, 6, and 12 months after surgery and every 6 months thereafter. Results: There was in-hospital vascular graft thrombosis in four (6.1 %) patients. No in-hospital deaths occurred. Median follow-up was 49.6 ± 33 months. Primary patency rates at 1-, 3-, 5-, and 10-year were 92.2 %, 85.6 %, 73.6 %, and 56.5 %, respectively. Seven patients passed away during follow-up of which four patients due to coronary artery disease, two patients due to cerebrovascular disease and one patient due to malignancy. Limb salvage rate after 1-, 3-, 5-, and 10-year follow-up was 100 %, 100 %, 96.3 %, and 91.2 %, respectively. Cox regression analysis including age, sex, risk factors for vascular disease, indication for treatment, preoperative ABI, lesion length, graft diameter and type of pre-procedural lesion (stenosis/occlusion), showed that only age (beta - 0.281, expected beta 0.755, p = 0.007) and presence of diabetes mellitus during index surgery (beta - 1.292, expected beta 0.275, p = 0.026) were found to be significant predictors of diminishing graft patency during the follow-up. Presence of diabetes mellitus during index surgery (beta - 1.246, expected beta 0.291, p = 0.034) was the only variable predicting mortality. Conclusions: Surgical treatment for unilateral iliac lesions in patients with premature atherosclerosis is a safe procedure with a low operative risk and acceptable long-term results. Diabetes mellitus and age at index surgery are predictive for low graft patency. Presence of diabetes is associated with decreased long-term survival.

Transapical versus Conventional Aortic Valve Replacement�A Propensity-Matched Comparison

2012 ◽  
Vol 15 (1) ◽  
pp. 4 ◽  
Author(s):  
David M. Holzhey ◽  
William Shi ◽  
A. Rastan ◽  
Michael A. Borger ◽  
Martin H�nsig ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Survival Rates ◽  
Long Term Results ◽  
Term Survival ◽  
Kaplan Meier ◽  
Risk Patients ◽  
Short And Long Term ◽  
Good Treatment Option ◽  
Matched Comparison

<p><b>Introduction:</b> The goal of this study was to compare the short- and long-term outcomes after aortic valve (AV) surgery carried out via standard sternotomy/partial sternotomy versus transapical transcatheter AV implantation (taTAVI).</p><p><b>Patients and Methods:</b> All 336 patients who underwent taTAVI between 2006 and 2010 were compared with 4533 patients who underwent conventional AV replacement (AVR) operations between 2001 and 2010. Using propensity score matching, we identified and consecutively compared 2 very similar groups of 167 patients each. The focus was on periprocedural complications and long-term survival.</p><p><b>Results:</b> The 30-day mortality rate was 10.8% and 8.4% (<i>P</i> = .56) for the conventional AVR patients and the TAVI patients, respectively. The percentages of postoperative pacemaker implantations (15.0% versus 6.0%, <i>P</i> = .017) and cases of renal failure requiring dialysis (25.7% versus 12.6%, <i>P</i> = .004) were higher in the TAVI group. Kaplan-Meier curves diverged after half a year in favor of conventional surgery. The estimated 3-year survival rates were 53.5% � 5.7% (TAVI) and 66.7% � 0.2% (conventional AVR).</p><p><b>Conclusion:</b> Our study shows that even with all the latest successes in catheter-based AV implantation, the conventional surgical approach is still a very good treatment option with excellent long-term results, even for older, high-risk patients.</p>

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