More than one-third of persons over seventy years of age have some degree of kidney disease. In the United States the majority of older persons with severe kidney disease are on hemodialysis. This is despite the fact that patients who receive peritoneal dialysis do as well and it is cheaper. At the American Society of Nephrology meetings, Dr Matthew Oliver,from the University of Toronto in Canada, pointed out that the majority of patients who are eligible for peritoneal dialysis were not offered it as a choice.

Given the choice, one third to one half of older patients would choose peritoneal dialysis over hemodialysis. The major reason for this is it can be done at home, saving the patient going into the dialysis center three times a week. The major contradiction to peritoneal dialysis is previous abdominal surgery or hernias. In most cases persons are not offered peritoneal dialysis, because the physician feels they would not be able to perform the actions necessary to  operate the peritoneal dialysis. Dr Oliver showed that a nursing care program at home would allow the majority of these patients to have peritoneal dialysis at home. His program found this was still cheaper than having hemodialysis. Patients receiving peritoneal dialysis spent less days in hospital.

Dr Erica Hartmann from Wake Forrest University discussed the role of renal transplantation in older persons. Her interest in this subject stemmed from her elderly grandfather having been refused a transplant.  She pointed out that transplantation more than doubles the survival of older patients over staying on dialysis. A person aged 75 to 79 years receiving a transplant will live another 7 years compared to less than three years if on dialysis. While older patients tend to have more complications, transplantation appears to  enhance  their quality of life. To increase available kidneys for transplant  the Eurotransplant Senior Program  has an “old for old” approach. This makes kidneys from older persons, that might not be suitable for younger persons, available for older persons.Extended criteria donors (mainly cadaver kidneys with less than a perfect immune match) are also becoming more commonly used in older persons. Transplants are in the future for elderly kidney failure patients.