My husband is 80 years old and has had a fistula inserted to begin dialysis. He has had colon cancer about 3 years ago and had part of his colon removed. He has high blood pressure. With this history what would be the lifespan after going onto dialysis?
Thanks Concernedwife

I only wish I could help: but my first rule of thumb is to try never to ‘predict’ survival - it is impossible to do so.

In addition, I know nothing of the medical course of your husband, how significant his 3 year history of colon cancer, his treatment for it, whether he has had successful clearance of it … and his other potential health issues - like his heart and his broader general health.

One thing is true: the older we get, the more the sum of many seemingly small health problems - at least small, each in their own right - can add together to make the whole a heavy weight.

There have been a number of sage and thought-provoking studies on dialysis in the elderly: yes or no - studies emanating mainly from the UK and from France, though Alvin Moss in the US recently published a wise and powerful piece ‘When enough is enough’ in the American Literature and has published widely on this subject (one that has long seemed oddly taboo, especially in the US). Interestingly, Alvin has used the exact same title as the information sheet I wrote for our patients here in Geelong back in 1993 and which we have since given out to every and all impending dialysis patients at our pre-dialysis education days over the two decade since. The nub of the data from the UK is that the elderly (their 'cut-off for elderly was >80) do not, as a whole, do much better on dialysis than with conservative care … if better at all.

Certainly, in their work, the elderly - if burdened by additional co-morbidities (cardiac or other) - struggle with dialysis. This does not mean that there are not older patients that do very well indeed with dialysis … dialysis professionals can all name many who have … but, as a group, the additional stresses, burdens and limitations of freedom and mobility imposed by dialysis grow greater with age. In addition, elderly folk ‘wear’ a lower eGFR better, in the main, than do the young and can remain generally well despite what seems like extremely low renal function … and remain so for ages. The UK data suggests that, in matched groups, survival is very similar between those who start dialysis and those who elect conservative care for >80 y/o patients with advanced CKD.

Only your nephrologist and local team can answer your question with any hope of being right … but again, I am always personally loathe to try to predict survival - even in patients I know well. One thing I can say, though, is that as my experience of CKD and dialysis grows, I am less and less pedantic about dialysis as the essential path to good survival in the elderly and more and more listen to the patient, try to weigh the aspirations and expectations and while offering dialysis as a possible course, also acknowledging that compassionate, careful, conservative care offers much too - and dialysis is not always the right path to take.

Whether any of that applies to your husband is way beyond my capacity to know … so chat to your doctor. Remember as you do that some doctors find these discussions just as difficult as do the patients and their families, and it can sometimes take a little while to dance around issues like death and/or survival till the core feelings of either side can be exposed.