Hemodialysis and the Elderly Patient: Potential Advantages as to Quality of Life, Urea Generation, Serum Creatinine, and Less Interdialytic Weight Gain

Successful treatment of patients with end-stage renal failure requires, in addition to dialysis, strict control of dietary, fluid and medication intake. In the present study we measured, in 50 chronic hemodialysis patients, serum potassium (K), serum phosphate (PO₄) and interdialytic weight gain as indices of diet, medication and fluid compliance, respectively. Dietary compliance did not correlate with fluid or medication compliance, whereas fluid intake and medication compliance were related (p = 0.01). Age, time on dialysis, place of birth and whether the patient came accompanied or not to the dialysis unit were the main variables affecting serum K levels. Sex, ethnic origin and education significantly affected serum PO₄. Sex, place of birth, marital status, number of children and years of education affected fluid intake. The compliance of the hemodialysis patient with different aspects of his regimen is thus multifactorial. Attempts to improve compliance and thus reduce morbidity and mortality should be aimed at identifying the population with low compliance and exposing them to educational programs.

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“…It has been reported that elderly patients have a better compliance than younger [8]. In our study age influences only dietary compliance.…”

Section: Discussionmentioning

confidence: 54%

Compliance in Hemodialysis Patients: A Multivariate Regression Analysis

Morduchowicz

Sulkes

Aizic

et al. 1993

Nephron

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“…Some characteristics that have been suggested to be important for adherence behavior in kidney transplant patients include fewer medical complications, age, cardiovascular risk, HIV infection, illicit drug use, and presence of severe mental psychopathology. [6][7][8][9] Several studies [10][11][12][13] have found older HD patients as well as older transplant patients 14 to be more adherent. Kimmel et al 15 found women to be more adherent with amount of time spent on HD as well as attendance at treatment.…”

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confidence: 99%

Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients

Cukor

Rosenthal

Jindal

et al. 2009

Kidney International

270

180

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End-stage renal disease (ESRD) is a growing public health concern and non-adherence to treatment has been associated with poorer health outcomes in this population. Depression, likely to be the most common psychopathology in such patients, is associated with increased morbidity and mortality. We compared psychological measures and self-reported medication adherence of 94 kidney transplant recipients to those of 65 patients receiving hemodialysis in a major medical center in Brooklyn, New York. Compared to the transplant group, the hemodialysis cohort was significantly more depressed as determined by the Beck Depression Inventory score. They also had a significantly lower adherence to medication as reported on the Medication Therapy Adherence Scale. Using hierarchical multiple regression analysis, the variance in depression was the only statistically significant predictor of medication adherence beyond gender and mode of treatment, accounting for an additional 12% of the variance. Our study strongly suggests that a depressive affect is an important contributor to low medication adherence in patients with ESRD on hemodialysis or kidney transplant recipients.

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“…Likewise, the duration of dialysis schedules may be reduced if RKF is factored into the prescription [48]. Given the limited prognosis on dialysis of the frail elderly, given the adverse consequences of aggressive dialysis regimes in this group, given their lower urea generation rates and lower interdialytic weight gains [58] and given the known benefits of RKF, there is a strong case for less aggressive dialysis strategies in these patients.…”

Section: Advantages and Potential Dangers Of Dialysismentioning

confidence: 99%

Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients

et al. 2015

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In the last decade, an increasing number of patients over 75 years of age are starting renal replacement therapy. Frailty is highly prevalent in elderly patients with end-stage renal disease (ESRD) in the context of the increased prevalence of some ESRD-associated conditions: protein-energy wasting, inflammation, anaemia, acidosis or hormonal disturbances. There are currently no hard data to support guidance on the optimal duration of dialysis for frail/elderly ESRD patients. The current debate is not about starting dialysis or managing conservatory frail ESRD patients, but whether a more intensive regimen once dialysis is initiated (for whatever reasons and circumstances) would improve patients' outcome. The most important issue is that all studies performed with extended/alternative dialysis regimens do not specifically address this particular type of patients and therefore all the inferences are derived from the general ESRD population. Care planning should be responsive to end-of-life needs whatever the treatment modality. Care in this setting should focus on symptom control and quality of life rather than life extension. We conclude that, similar to the general dialysed population, extensive application of more intensive dialysis schedules is not based on solid evidence. However, after a thorough clinical evaluation, a limited period of a trial of intensive dialysis could be prescribed in more problematic patients.

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Hemodialysis and the Elderly Patient: Potential Advantages as to Quality of Life, Urea Generation, Serum Creatinine, and Less Interdialytic Weight Gain

Cited by 34 publications

References 8 publications

Compliance in Hemodialysis Patients: A Multivariate Regression Analysis

Compliance in Hemodialysis Patients: A Multivariate Regression Analysis

Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients

Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients

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