The mean age of the ESRD population continues to increase, with the 2011 USRDS Annual Data report noting it to be 62.6 years among a prevalent chronic dialysis population (both hemo- and peritoneal dialyses) of approximately 399,000. As with previous reports, the greatest growth rate per million population in the ESRD cohort occurs in age range >75 years. Entering the ESRD pool >75 years of age are about 5,000 patients/million population; in contrast, the number is about 2,100/million population that falls in the age range 45-65 years. Baseline comorbid conditions, especially complications associated with diabetes and cardiovascular disease (CVD), accelerate with duration of ESRD, and compound the already high morbidity and mortality. With aging comes progressive vascular disease, making it more likely that the elderly will have a central venous catheter (CVC) access, rather than a fistula, for starting and continuing dialysis, hence, increased hospitalization and death rates associated with access clotting and infection (sepsis). The scenario in the elderly patient on dialysis is often a poor quality of life with repeated hospitalizations and eventual nursing home placement. For those patients who survive such a disabled state leads to the question whether chronic dialysis therapy is the best option. Our goal as committed nephrologists is to deliver compassionate, quality care. In the sick, older patient let us rethink what is the best option as they enter ESRD.
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