Survival of Older Patients With Advanced CKD Managed Without Dialysis: A Narrative Review

Chou, Angela; Li, Kelly; Brown, Mark

doi:10.1016/j.xkme.2022.100447

Cited by 16 publications

(10 citation statements)

References 47 publications

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“…Given the uncertainties in outcomes and the varied value individuals may place on potential outcomes, informed SDM with patients and their families is crucial when determining the most appropriate therapeutic pathway. SDM should consider not only clinical perspectives but also QoL and logistical perspectives [ 13 ]. Furthermore, it is important to acknowledge that the decision to proceed with dialysis or CKM also affects caregivers, although definitive evidence is lacking.…”

Section: Why Sdm Should Be the Preferred Management Approachmentioning

confidence: 99%

Shared decision making in elderly patients with kidney failure

Kanbay,

Basile,

Battaglia

et al. 2023

Nephrology Dialysis Transplantation

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‘Elderly’ is most commonly defined as an individual aged 65 years or older. However, this definition fails to account for the differences in genetics, lifestyle and overall health that contribute to significant heterogeneity among the elderly beyond chronological age. As the world population continues to age, the prevalence of chronic diseases, including chronic kidney disease (CKD), is increasing and CKD frequently progresses to kidney failure. Moreover, frailty represents a multidimensional clinical entity highly prevalent in this population, which needs to be adequately assessed to inform and support medical decisions. Selecting the optimal treatment pathway for the elderly and frail kidney failure population, be it hemodialysis, peritoneal dialysis, or conservative kidney management is complex, because of the presence of comorbidities associated with low survival rates and impaired quality of life. Management of these patients should involve a multidisciplinary approach including doctors from various specialties, nurses, psychologists, dieticians, and physiotherapists. Studies are mostly retrospective and observational, lacking adjustment for confounders or address selection and indication biases, making it difficult to use these data to guide treatment decisions. Throughout this review we discuss the difficulty of making a one-size-fits-all recommendation for the clinical needs of older patients with kidney failure. We advocate that a research agenda for optimization of the critical issues we present in this review be implemented. We recommend prospective studies that address these issues, and systematic reviews incorporating the complementary evidence of both observational and interventional studies. Furthermore, we strongly support a shared decision making process matching evidence with patient preferences to ensure that individualized choices are made regarding dialysis vs. conservative kidney management, dialysis modality, and optimal vascular access.

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Section: Why Sdm Should Be the Preferred Management Approachmentioning

confidence: 99%

Shared decision making in elderly patients with kidney failure

Kanbay,

Basile,

Battaglia

et al. 2023

Nephrology Dialysis Transplantation

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“…CKM is a non-dialysis treatment strategy for advanced CKD that is considered a suitable alternative to dialysis among certain older adults. Emerging evidence suggests that CKM is associated with comparable survival and HRQoL outcomes to dialysis in adults aged over 80 years with significant comorbidity [ 4–7 ].…”

Section: Conservative Kidney Management and Supportive Dialysis In Th...mentioning

confidence: 99%

“…Current evidence suggests that health-related quality of life (HRQoL) and symptom burden are similar for dialysis and non-dialysis approaches to end-stage kidney disease (ESKD) management in older adults. Although dialysis may improve survival compared with conservative management, this benefit is largely mitigated amongst the oldest patients and those living with significant comorbidity [ 4–7 ]. Furthermore, older adults tend to experience functional and cognitive decline after dialysis initiation, as well as an increased risk for hospitalization [ 5 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

A review of supportive care for older people with advanced chronic kidney disease

Fitzgerald

Joosten

Buren

et al. 2022

Clinical Kidney Journal

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Supportive care (SC) is a multidimensional and person-centred approach to managing advanced CKD that engages the person and their caregivers in shared decision making from the outset. Rather than focussing on disease-specific therapies, SC is a collection of adjuvant interventions and adaptations to conventional treatments that can be used to improve the individual's quality of life. Recognising that frailty, multi-morbidity, and polypharmacy are more common among older people with advanced chronic kidney disease (CKD) and that people in this group tend to prioritise quality of life over survival as a goal of care, SC represents an important adjunct to disease-specific therapies in CKD management. This review provides an overview of SC in the older person with advanced CKD.

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“…It is a process of purifying the blood from wastes through a semipermeable membrane acts as artificial kidney (Gite, 2020). The number of patients receiving HD has increased globally, with the elderly population demonstrating the most rapid growth rate (Chou et al, 2022). HD treatment is accompanied by many complications such as fatigue, muscle cramps, hypotension, disequilibrium syndrome, nausea, body aches and headache, (Gite, 2020;Paul & Das, 2022).…”

Section: Introductionmentioning

confidence: 99%

Effect of Intradialytic Stretching Exercises on Muscle Cramps among Elderly Patients Undergoing Hemodialysis

Elsedawy

Mohsen

El-saidy

et al. 2023

Menoufia Nursing Journal

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Background: Muscle cramps occur frequently among elderly hemodialysis patients, which can be avoided by the application of intradialytic stretching exercises. Purpose: Determine the effect of intradialytic stretching exercises on muscle cramps among elderly patients undergoing hemodialysis. Setting: The study was conducted at hemodialysis unit in Meet Khaqan Health Center affiliated to Shebin El-Koum Fever Hospital. Sample: The study subjects comprised of a convenience sample of 50 elderly patients who were registered in dialysis unit's files. Instruments: First, Structured interviewing questionnaire. Second, cramp questionnaire chart and visual analogue scale. Results: There was a highly statistically significant difference in the level of muscle cramps pre and post implementation of intradialytic stretching exercises (p < 0.001**). Conclusion:There was a significant reduction in the muscle cramps level after application of the intradialytic stretching exercises. Thus, these exercises are an effective and simple measure to prevent or reduce severity of muscle cramps among elderly hemodialysis patients. Recommendations: Intradialytic stretching exercises should be combined with routine nursing care for hemodialysis patients.

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Survival of Older Patients With Advanced CKD Managed Without Dialysis: A Narrative Review

Cited by 16 publications

References 47 publications

Shared decision making in elderly patients with kidney failure

Shared decision making in elderly patients with kidney failure

A review of supportive care for older people with advanced chronic kidney disease

Effect of Intradialytic Stretching Exercises on Muscle Cramps among Elderly Patients Undergoing Hemodialysis

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