According to new data released today by the Canadian Institute for Health Information (CIHI), one in four patients (1,490 out of 5,354) who started treatment for end-stage renal disease (kidney failure) in 2003 was 75 or older. In contrast, these older seniors represented one in seven patients (420 of 3115) receiving treatment for kidney failure in 1994. While the total number of kidney failure patients on dialysis increased 72% in the same decade, the increase in the number of older seniors more than tripled.
« The growth in older seniors starting renal replacement therapy-also known as dialysis-outpaces the growth rate of that age group’s population. This illustrates that the rise in end stage renal disease isn’t solely a factor of Canada’s aging population, » explains Dr. Vanita Jassal, a gerontological nephrologist and an expert advisor to CIHI. « There is information to suggest that this trend is due to a rise in kidney failure among older seniors, as suggested by increased hospitalizations and deaths due to chronic renal failure, as well as to increased access to dialysis treatment. »
End-stage renal disease is a progressive disease where the loss of kidney function becomes life threatening. Dialysis and kidney transplantation are the treatment options for patients with this disease.
« More patients are being referred to nephrologists and being accepted into dialysis programs due to the expansion of dialysis services across the country and general improvements in dialysis care, » Dr. Jassal says. « If we look at the international picture, we see a similar growth in the treatment of patients aged 75 and older. »
On December 31, 2003, there were 18,153 patients receiving dialysis for kidney failure. Twenty seven percent of these dialysis patients (4,889) were 75 years or older. In 1994, older seniors represented 14% of all patients receiving treatment for kidney failure (1,229 out of 8,908).
Growth Rates Greater for Women Over 75
Although there are more men than women receiving dialysis for kidney failure, the growth in new female patients aged 75 and older receiving dialysis surpassed that for males during the decade of study. Sex-age-specific rates rose from 186 per million population in 1994 to 580 in 2003 for females, more than tripling the rate. The rate for males more than doubled, from 495 per million population in 1994 to 1,143 in 2003.
There were also significant differences between the sexes in the older senior patients when it came to overall health. Male patients aged 75 and over were more likely to have heart disease, chronic lung disease and peripheral vascular disease than their female counterparts. However, increases in hospitalizations and deaths from chronic renal failure did not show this gender difference.
Provincial Trends
Provincial trends revealed the same pattern observed nationally, although some provinces didn’t record the same upward trend among older senior patients receiving treatment in 2001-2003. Age-specific rates varied among the provinces. For the period 2001-2003, Quebec reported the lowest rate of new dialysis patients 75 and older, at 587 per million population, while Ontario reported the highest rate at 889 per million.
On December 31, 2003, patients aged 75 and older comprised 35% of all actively treated dialysis patients in Nova Scotia. In contrast, only 17% of the dialysis patients in Manitoba were 75 years or older. The highest rate of patients older than 75 receiving dialysis for kidney failure at 2003 year-end was in Alberta, at 3,259 per million population, followed by Ontario, at 3,035. The lowest rate was in Saskatchewan, at 1,909 per million population.
How Do Patients Aged 75 and Over Differ From Younger Ones?
Although the increased prevalence of diabetes has contributed to the overall rise in end-stage renal disease, patients 75 years and older were less likely than younger patients to have diabetes as either a primary or secondary cause of kidney failure. Over 40% of these older senior patients had kidney failure caused by renal vascular disease with hypertension, a much greater proportion than found among younger patient groups.
Interestingly, new dialysis patients 75 years and older were healthier overall than the age group immediately before them. The older seniors did not have a higher prevalence of significant risk factors like heart disease, cerebrovascular disease, chronic lung disease or peripheral vascular disease when compared with patients aged 65 to 74.
« Many fitter, healthier elderly patients starting dialysis fare at least as well as their younger counterparts who have more comorbidities, » says Dr. Jassal. « Older senior patients are, however, much more vulnerable to the problems associated with ageing which may affect their level of independence and their long-term prognosis. The primary aim of dialysis is to enable patients to live with their desired level of independence and an acceptable quality of life. This can be achieved only by recognizing the unique requirements of the elderly kidney failure patient population. »
For further information: Leona Hollingsworth, (613) 241-7860, ext. 4140,
Cell: (613) 612-3915; Jill Oviatt, (613) 241-7860, ext. 4310, Cell: ; ; ; ; ; ;
(613) 612-3914