Home dialysis in older adults: challenges and solutions

Abstract

There is a rising demand for dialysis in the older population given the increased numbers of older adults living with chronic kidney disease (CKD) progressing to kidney failure. Home dialysis i.e. peritoneal dialysis (PD) and home hemodialysis (HHD) has been available for decades, but more recently, there has been a rapid increase in home dialysis utilization as patients and clinicians consider its practical and clinical advantages. For older adults, incident home dialysis utilization more than doubled and prevalent home dialysis growth nearly doubled over the past decade. Whilst its advantages and recent rise in popularity are evident, there are numerous barriers and challenges that are important to consider prior to initiating older adults on home dialysis. Some nephrology healthcare professionals do not view home dialysis as an option for older adults. Successful delivery of home dialysis for older adults may be made even more difficult by physical or cognitive limitations, concerns around dialysis adequacy, treatment-related complications, as well as challenges relating to caregiver burnout and patient frailty that are unique to home dialysis and older adults. Ultimately, it would be important for clinicians, patients and their caregivers to define what constitutes a ‘successful therapy’ to ensure treatment goals are aligned towards each individual's priorities of care, considering the complex challenges that surrounds an older adult receiving home dialysis. In this review, we evaluate some of the key challenges surrounding the delivery of home dialysis to older adults and propose potential solutions based on updated evidence to overcome these challenges.

Correlation of the caring behaviour of nurses with the motivation of patients undergoing haemodialysis

“…indicating that haemodialysis patients may also include older individuals. 2 Therefore, the average age of patients undergoing haemodialysis can range from the mid-40s to older ages, reflecting the diverse demographic characteristics of this patient population. 9 Patients undergoing haemodialysis therapy are dominated by chronic kidney disease (CKD) sufferers.…”

“…Risk factors such as diabetes mellitus, hyperuricaemia and obesity have been identified as significant contributors to the development of CKD. 2,27,28 Additionally, the presence of comorbidities such as diabetes mellitus and hypertension, which are common in middle-aged individuals, may increase the risk of CKD. 29 Additionally, a correlation between hypertension and the occurrence of CKD has been highlighted, indicating that individuals with hypertension, which often develops in middle age, may have a higher risk of developing CKD.…”

“…Studies have shown that patients undergoing haemodialysis face numerous challenges, including physical, psychological and socioeconomic issues. 1,2 These challenges can impact their quality of life and overall well-being. 3,4 Furthermore, the process of transitioning to haemodialysis presents a significant challenge for patients, as it involves accepting and adapting to the treatment.…”

Personalized peritoneal dialysis prescription—beyond clinical or analytical values

“…Elderly patients with ESKD who undergo PD often display frailty, and some may require palliative care due to their poor prognosis. Tailoring a dialysis prescription to the specific needs of these patients, focusing on symptom control and maintaining QoL, can help minimize their treatment burden [ 13 , 15 , 64 , 65 ]. The process begins with a screening to identify those patients who would benefit most from this approach to PD prescription [ 14 , 64 ].…”

Towards a better uptake of home dialysis in Europe: understanding the present and looking to the future

“…Incorporating SDM and person-centered care into dialysis practice should also enable more older people to choose home dialysis. Home dialysis has challenges for older people [ 70 ] and can be made more feasible with assistance from paid healthcare workers or by family members [ 71 ]. Currently only 5 of 13 Western European countries offer assistance by paid healthcare workers [ 26 ] leading to higher proportions of older people on PD.…”