Heather Jayasekera, Research & Practice Development Sister at Hope Hospital, Salford, has been looking at patient mortality, their hospitalisation, their vascular access, and their quality of life in relation to age.

		The data analysis from the DOPPS study has confirmed to us:
		the risk of death rate increases with age,
		the risk of hospitalisation increases with age,
		and the patients' physical quality of life decreases with age while their mental quality of life remains relatively constant".

"And our older patients are less likely to start haemodialysis with a functioning fistula while our younger patients are less likely to start haemodialysis with permanent access," she said.

Patients in her study were separated into age-groups 18 to 44; 45 to 64; 65 to 74, and the 75s plus. They were compared with a control group aged 45 to 64.

She found that risk of death was statistically greater among haemodialysis patients even when patients were adjusted for demographics, co-morbidity and country of residence.

"When analysing episodes of hospitalisation, crude hospitalisation rates significantly increase with age," Heather Jayasekera continued.

"Compared with the control group, the 18 to 64 age group is not significantly different, whereas the older age groups are statistically different in that patients are more likely to be hospitalised."

She also compared the hospitalisation rate between non-incident patients and incident patients and found that hospitalisation rates in the incident patients were not statistically different, however hospitalisation rates in the non-incident patients were significantly different for the older age groups.

Non-incident patients were those entering DOPPS who had been established on maintenance haemodialysis for longer than three months. Incident patients were those who entered the study within 90 days of their first haemodialysis treatment.

"But when examining the length of hospital stay the only statistical difference is in the 65 to 74 and the 75 plus age groups, where there is a slight increase in length of stay," she said.

"It is probably a surprise to all of us in the UK that this increase in length of hospital stay in such an elderly population is as little as one day.

The 65 to 74 and the 75 plus age groups did not differ from the 45- to 64-year-old group in terms of starting dialysis with a temporary as opposed to a permanent access. The only significant difference was in the 18 to 44 age group, who are more likely to begin dialysis with temporary access.

"The biostatisticians do not clearly state why they are seeing this but I think, from a clinical point of view, it's possible that it may be as result of factors including, acute admission in this younger age group or resulting from a delay in the pre-dialysis care of this age group," she said.

"When looking at commencing haemodialysis and comparing the AV fistula with that of the synthetic graft, it is the 18 to 44 and the 65 to 74 year age groups who are more likely to commence haemodialysis with a fistula compared with the 75 plus, who are likely to start with a synthetic graft," Heather Jayasekera concluded.