Dialysis in the elderly patient: a challenge of the XXI century - narrative review

Abstract

With the increase in life expectancy, the improvement of therapeutic arsenal, knowledge and control of chronic degenerative diseases, the world population has reached older age groups. As advanced age is a risk factor for chronic kidney disease (CKD), along with the bonus of increased survival, today we are experiencing the greatest burden of progressive incidence of elderly patients on renal replacement therapy (RRT). Dialysis in elderly patients, which for three decades was considered out of question, today is a routine for nephrologists, who face the challenge of providing care to elderly patients with CKD stage 5 with dialysis indication. In fact, what we see nowadays are dialysis incidents elderly patients as the fastest growing group on RRT. Although without reaching a consensus, it seems indisputable that for elderly patients with CKD, the most important is the quality of life. In this paper we discuss the dialysis in the elderly patient.

Predictive Parameters Functioning Arteriovenous Fistula for Hemodialysis in the Elderly

“…This could be in conflict with the current clinical practice guidelines. In fact, strict application of these recommendations may be inappropriate for certain patients (3,(10)(11)(12).…”

Health-related quality of life in elderly chronic kidney disease patients undergoing hemodialysis

“…According to demographic data, it is also happening in other nations because the population ageing is a global phenomenon. Regarding the number of elderly people in each country of the world, it is believed that Brazil will occupy the sixth place by 2025 [1].…”

How much is enough? An investigation of the relationship between haemodialysis adequacy and quality of life of elderly patients

“…The 2013 Australian and New Zealand Dialysis and Transplantation Registry further revealed that there were 2484 people aged 75 years and above receiving haemodialysis, being 27% of all haemodialysis patients, and this number includes 447 people aged over 85 years, a rise of 7% from 2011 . This trend has been attributed to an increase in the life expectancy, improvement of the therapeutic arsenal, and knowledge and control of comorbid diseases . As a result, the number of elderly patients requiring replacement therapy is growing.…”

“…2 This trend has been attributed to an increase in the life expectancy, improvement of the therapeutic arsenal, and knowledge and control of comorbid diseases. 3 As a result, the number of elderly patients requiring replacement therapy is growing. Several studies have also noted this drastic increase of the elderly population receiving dialysis.…”

“…[4][5][6] There are several challenges associated with caring for elderly patients on dialysis. Most of the problems stem from the complexity of their comorbidities, need for interdisciplinary care and assessment of their functional status, 3 late referrals, limited treatment alternatives, difficulties with dialysis vascular access 6 and the need to balance their quality of life (QoL) with a suitable therapeutic approach. The benefit of dialysis to this population group has received widespread scrutiny.…”