Acute dialytic support of the octogenarian : is it worth it ?

Dialytic support of the elderly has recently come under scrutiny. The consumption of resources and the lack of clear data on outcome have fueled the controversy. In an effort to establish a baseline, we reviewed our experience over the past 5 years of ICU dialysis therapies delivered to patients over 80 years old. Data were prospectively collected for an ICU Renal Registry and included admission diagnosis, presence of pre existing renal dysfunction (serum creatinine > or = 1.5 mg/dl), APACHE score at both ICU entry (A1) and consultation (A2), presence of multiorgan failure (MOF), pressor support (PS), nutritional support (NS), therapy type used (both prescribed and delivered), and outcome, either as ICU discharge, return of renal function, or withdrawal. A total of 21 patients (average age 82.6; range, 80-88 years) consisting of 4-8% of the yearly consultations underwent renal replacement therapy. The majority of patients were surgical (20/21); 61.9% had pre-existing renal dysfunction (serum creatinine 2.1 +/- 1.4 mg/dl) and presented with ARF from ischemic/toxic causes (17/21) or other causes (4/21). Virtually all patients had MOF (20/21) with moderately elevated APACHE scores (A1: 20.9, A2: 21.3). Eighty-six percent received PS, and 90% received NS. Renal therapy consisted of only intermittent (9/21), only continuous (4/21), or a combination (8/21). These data were compared with those of 80+ year old patients who underwent surgery but did not require dialysis, as well as with those of non 80 year old dialysis supported ICU patients over the same 5 year period. Patient outcome reflected a 33.3% overall survival and a 28.5% renal recovery.