The dialysis population has grown rapidly in the past decade, as a consequence of government support for catastrophic illness and broadening of the indications for patient selection. Progress in the management of patients on hemodialysis has resulted in a steady increase in the number of surviving long-term patients with end stage renal disease. As a result, this population includes large numbers of older subjects, as well as individuals with systemic diseases, in whom establishment and maintenance of adequate vascular access is particularly difficult. The success of vascular access in the elderly patients depends upon proper selection of the type and location of the A-V fistula, and upon prompt and aggressive management of any developing complications. While experience with transplantation in elderly patients has significantly improved in recent years, careful evaluation of the elderly potential allograft recipient may improve patient and graft survival, by identifying those patients in whom the risk involved may be prohibitive. In addition, growing knowledge and judicious use of immunosuppressive medications have further improved the outcome following transplantation. In the absence of any obvious contraindications, transplantation is a safe, effective treatment modality for end-stage renal disease in elderly patients.
- dialysis access
- immune function