Dialysis Therapies in Older Patients with End-Stage Renal Disease

Malavade, Tuschar; Sokwala, Ahmed; Jassal, Sarbjit V.

doi:10.1016/j.cger.2013.05.005

Cited by 7 publications

(5 citation statements)

References 88 publications

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“…Older individuals treated with HD are also more frequently affected by pain, sleep disturbances and depression than younger patients 233 . Based on a qualitative study 234 , researchers identified predictors of better outcomes in older individuals on dialysis.…”

Section: Hd Outcomes In Vulnerable Populationsmentioning

confidence: 99%

Epidemiology of haemodialysis outcomes

et al. 2022

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Haemodialysis (HD) is the commonest form of kidney replacement therapy in the world, accounting for approximately 69% of all kidney replacement therapy and 89% of all dialysis. Over the last six decades since the inception of HD, dialysis technology and patient access to the therapy have advanced considerably, particularly in high-income countries. However, HD availability, accessibility, cost and outcomes vary widely across the world and, overall, the rates of impaired quality of life, morbidity and mortality are high. Cardiovascular disease affects more than two-thirds of people receiving HD, is the major cause of morbidity and accounts for almost 50% of mortality. In addition, patients on HD have high symptom loads and are often under considerable financial strain. Despite the many advances in HD technology and delivery systems that have been achieved since the treatment was first developed, poor outcomes among patients receiving HD remain a major public health concern. Understanding the epidemiology of HD outcomes, why they might vary across different populations and how they might be improved is therefore crucial, although this goal is hampered by the considerable heterogeneity in the monitoring and reporting of these outcomes across settings.

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Section: Hd Outcomes In Vulnerable Populationsmentioning

confidence: 99%

Epidemiology of haemodialysis outcomes

et al. 2022

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“…Recently, PD has been less frequently utilized [ 10 ], owing not only to the autonomy, comorbidity, and performance of the patients, but also financial, resource availability, and cultural issues [ 11 ]. Moreover, in Korea, incident PD patients are decreasing, as compared to HD patients [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Elderly Peritoneal Dialysis Compared with Elderly Hemodialysis Patients and Younger Peritoneal Dialysis Patients: Competing Risk Analysis of a Korean Prospective Cohort Study

Kim

et al. 2015

PLoS ONE

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The outcomes of peritoneal dialysis (PD) in elderly patients have not been thoroughly investigated. We aimed to investigate the clinical outcomes and risk factors associated with PD in elderly patients. We conducted a prospective observational nationwide adult end-stage renal disease (ESRD) cohort study in Korea from August 2008 to March 2013. Among incident patients (n = 830), patient and technical survival rate, quality of life, and Beck’s Depression Inventory (BDI) scores of elderly PD patients (≥65 years, n = 95) were compared with those of PD patients aged ≤49 years (n = 205) and 50~64 years (n = 192); and elderly hemodialysis (HD) patients (n = 315). The patient death and technical failure were analyzed by cumulative incidence function. Competing risk regressions were used to assess the risk factors for survival. The patient survival rate of elderly PD patients was inferior to that of younger PD patients (P<0.001). However, the technical survival rate was similar (P = 0.097). Compared with elderly HD patients, the patient survival rate did not differ according to dialysis modality (P = 0.987). Elderly PD patients showed significant improvement in the BDI scores, as compared with the PD patients aged ≤49 years (P = 0.003). Low albumin, diabetes and low residual renal function were significant risk factors for the PD patient survival; and peritonitis was a significant risk factor for technical survival. Furthermore, low albumin and hospitalization were significant risk factors of patient survival among the elderly. The overall outcomes were similar between elderly PD and HD patients. PD showed the benefit in BDI and quality of life in the elderly. Additionally, the technical survival rate of elderly PD patients was similar to that of younger PD patients. Taken together, PD may be a comparable modality for elderly ESRD patients.

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“…5 In the absence of home support, the majority of elderly patients are placed on in-center hemodialysis primarily for safety concerns. 5-7…”

Section: Drawbacks Of Home Dialysismentioning

confidence: 99%

“…5,6 Elderly patients also experience significant reductions in their QoL and may be burdened with pain, sleep disturbances, and depression. 5-8 However, goal-oriented dialysis offers a patient-centered approach, possibly leading to better QoL outcomes in elderly patients.…”

Section: Introductionmentioning

confidence: 99%

Home Dialysis Among Elderly Patients: Outcomes and Future Directions

Auguste

Chan

2019

Can J Kidney Health Dis

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Elderly patients who receive home dialysis (peritoneal dialysis or home hemodialysis) may have reduced survival compared to younger patients. Therefore, it is important to ascertain the goals of home dialysis in the elderly rather than simply fixate on standard metrics such as technique survival. As Canada’s population continues to age, the prevalence of end-stage kidney disease among the elderly population is increasing. Patients with multiple comorbidities are now surviving long enough to be started on dialysis. Although home dialysis has been associated with better survival and improved quality of life, its impact on the frail and elderly populations require further elucidation. Home dialysis patients can either independently perform tasks or have support in the home to safely conduct dialysis. Moreover, patients burdened with frailty and multiple comorbidities who lack support in the home may not be able to perform home dialysis safely. Innovative strategies to improve accessibility to home-based therapies need further exploration. In addition, the concept of goal-directed dialysis promotes more individualized treatment. Future continuous quality improvement initiatives must examine if goal-directed dialysis leads to better quality of life outcomes in the elderly.

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Dialysis Therapies in Older Patients with End-Stage Renal Disease

Cited by 7 publications

References 88 publications

Epidemiology of haemodialysis outcomes

Epidemiology of haemodialysis outcomes

Elderly Peritoneal Dialysis Compared with Elderly Hemodialysis Patients and Younger Peritoneal Dialysis Patients: Competing Risk Analysis of a Korean Prospective Cohort Study

Home Dialysis Among Elderly Patients: Outcomes and Future Directions

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