Ethical considerations in nephro-geriatrics

Abstract

Life expectancy and quality of life may be rather poor in elderly patients with chronic kidney disease stage V. This raises a number of issues surrounding the decision of whether or not to commence renal replacement therapy and about the right timing of this. Those starting dialysis appear to have a better outcome; however, important selection bias is very likely and the survival advantage offered by dialysis is markedly reduced in patients with severe comorbidities. Moreover, those commencing dialysis are more likely to be hospitalized than those managed conservatively. Cognitive impairment, dependence on daily activities, comorbidities, and life expectancy are relevant factors that need to be considered in order to decide whether or not to start dialysis. However, guidelines and severity scores are still of little help. Cultural, religious, legal, and educational aspects further complicate the scene.

Geriatric Assessment for Therapeutic Decision-Making Regarding Renal Replacement in Elderly Patients with Advanced Chronic Kidney Disease

“…In this regard, it is difficult to predict the prognosis and decide which patients could benefit from replacement therapy or from conservative care [1,2,3]. Nephrologists should apply geriatric concepts [4,5,6,7], like frailty, in the management of older patients with advanced CKD. The term ‘frail elderly' was first used in 1974 by the Federal Council on the Aging.…”