Nurse team leader in the Haemodialysis Unit at the Lister Hospital, Stevenage, Victoria Riggs used the data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) to look at the health differences among age groups of haemodialysis patients within the study. She looked especially at health differences and adherence to diet among age groups in the seven participating countries: France Germany, Italy, Japan Spain UK and USA.

She found that the age distribution is similar in each country. Mean age is 61 years. In England, it is 58.6 years.

"This has increased rapidly over the past 10 years, possibly due to increased GP awareness of renal failure; people living longer; and dialysis units changing their patient acceptance protocols," she explained.

The main causes of renal failure she noted were diabetes, hypertension; glomerulonephritis (GN); and a group of causes she collectively described as "other causes".

"In younger patients, 'other causes' are the main factors for development of end-stage renal disease. These include polycyctic disease and pylonephritis.

"In older patients, hypertension is one of the dominant causes, including renal vascular disease.

"Elderly patients also have a higher incidence of coronary artery disease and congestive heart failure. But cardiovascular disease is much more common among all age-groups of patients with chronic renal failure that in the general population," Victoria Riggs explained.

Victoria Riggs also found that the elderly had the highest incidence of "unstable treatments", although the incidence of these was generally low. Unstable haemodialysis treatments are defined as a session which needs extra nursing care for reasons such as hypertension, vomiting, nausea or headaches, she explained.

"This may be due to use of ultrafiltration programmes, greater nurse awareness of their patients' tolerances, and generally patients being more compliant with their fluid intakes," she suggested.

Delivered dose of Kt/V was the same among all age groups, but protein nitrogen appearance (PNA) or NPCR decreased with increase in age groups, she added.

"This implies that, apart from adequate dialysis, older patients are more malnourished, indicating outside restraints. These may be lack of appetite, loneliness, lethargy, inability to cook, hospital admissions or, on dialysis days, not actually eating at all," she said.

In response to a question from the floor, Victoria Riggs agreed that renal units could, where appropriate, consider feeding patients while they dialyse to combat this problem.

DOPPS data also suggests that younger patients are more likely than elderly patients to skip or shorten treatments. A skipped treatment was when a patient missed one or more treatments over the past 30 days. A shortened treatment was when a patient missed 10 or more minutes of a dialysis session, Victoria Riggs explained.

"Here there was a reversal of ages," she said.

"The younger patients had more skipped and shortened treatments that the elderly.

"This could be due to lack of interest in their illness, leading to lack of importance of dialysis within their lives. Work and family commitments were also very important and generally younger patients appear to have a busier life style that older patients."

Adherence to treatment was measured by chemistry values with less-compliant younger patients having higher fluid gains, higher phosphorus levels, and high potassium levels.

"But if the elderly population is suffering from malnutrition, then this will reflect in lower chemistry values," Victoria Riggs stressed.

"These outcomes are very useful but further work needs to be carried out to help increase NCPR results, decrease unstable and missed treatments, and combat the ongoing problem of non-adherence," Victoria Riggs concluded.

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