Chronic peritoneal dialysis in the elderly

Available data indicate that peritoneal dialysis (PD) offers some advantages for the increasing number of elderly patients with ESRD, such as hemodynamic stability, steady-state metabolic control, good control of hypertension, independence from hospital visits, and avoidance of repeated vascular access. Early referral promotes the establishment of peritoneal access and minimizes the consequences of uremia and subsequent morbidity and frequent hospitalization. Elderly patients have similar modality-related complications such as peritonitis, catheter-related complications, exit-site and tunnel infection, and hernias as younger patients. Comorbid conditions, malnutrition, and psychosocial status influence the survival of elderly patients on PD. Elderly patients are compliant and highly motivated to cooperate in treatment. They are more tolerant of changes and losses and have a greater sense of well-being, less illness and modality-related stress, and fewer mood disturbances. Despite comorbid conditions, that significantly impair self-performance of dialysis, PD can be performed successfully if they have family support or access to a network of medical and social support, that is, home nurses, rehabilitation services, and chronic care dialysis units, or nursing homes.