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Dialysis in the elderly. New possibilities, new problems.
1Renal and Transplant Unit, Nottingham City Hospital NHS Trust, Nottingham, UK. mcassidy@ncht.trent.nhs.uk
Summary
The number of elderly patients undergoing renal replacement therapy (RRT) is rising. This review examines the unique needs of older adults on dialysis, including specific care considerations and prognosis.
Area of Science:
- Geriatric Nephrology
- Renal Replacement Therapy
Background:
- Significant increase in elderly patients requiring renal replacement therapy (RRT) over the past two decades.
- This demographic trend in kidney disease is projected to continue.
Purpose of the Study:
- To review the changing demographics of the renal patient population.
- To discuss the specific needs and challenges of elderly patients undergoing RRT.
- To explore considerations for dialysis, comorbidities, and end-of-life care in older adults.
Main Methods:
- Review of current literature on elderly patients receiving RRT.
- Analysis of demographic trends in nephrology.
- Discussion of clinical considerations for geriatric dialysis patients.
Main Results:
- Older adults can significantly benefit from dialysis despite increased comorbidities.
- Key challenges include dialysis modality, vascular access, malnutrition, falls, cognitive impairment, and pain management.
- Prognosis and end-of-life care discussions are crucial for informed decision-making.
Conclusions:
- Elderly patients represent a growing population on RRT with distinct care requirements.
- Tailored approaches to dialysis, symptom management, and prognostication are essential.
- Nephrologists must be adept at discussing treatment options, including withdrawal, and palliative care.