Outcome of intensive care treatment and rehabilitation in multimorbid elderly patients with chronic renal failure

From a medical and ethical point of view, the question frequently arises whether intensive care treatment in multimorbid elderly patients is justified by its outcome. This applies in particular to patients with chronic renal failure.

Patients and methods

In a descriptive study, 23 consecutive patients (group 1; mean age 71.5 years) with chronic renal failure requiring intensive care treatment and at least three severe accompanying diseases underwent standard geriatric assessment (ICIDH, Barthel Index, Tinetti test, up & go test, clock completion test) when transferred for rehabilitation. All patients underwent medical rehabilitation for 4–10 weeks after discharge from the ICU. Forty geriatric patients with normal renal function (group 2; mean age 75.5 years) requiring ICU treatment and subsequent rehabilitation served as controls. All patients were reassessed when leaving the rehabilitation center.

Results

In 12 patients of group 1, the rehabilitation measures restored a functional level comparable to that before admission to the ICU. With two exceptions, all patients of group 1 could return to their former environment. The improvement in the Barthel index after rehabilitation was not significantly different from that of the control group (16.3 versus 18.6 points). Lethality was significantly higher in group 1 (16 versus 4%).

Conclusion

Multimorbid elderly patients with end-stage renal disease benefit from ICU treatment and rehabilitation in a similar way as geriatric patients with normal renal function.