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06:27
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Published on: July 20, 2022
[Should dialysis be for all? Yes indeed!]
G Panzetta1, M Grignetti, G Toigo
1S.C. di Nefrologia e Dialisi, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Trieste, Italy.
Summary
Dialysis for patients over 75 is ethically complex, not clinically limited. Despite challenges, survival and rehabilitation for the very elderly are comparable to younger groups, emphasizing quality of life over technical constraints.
Area of Science:
- Nephrology
- Geriatrics
- Bioethics
Context:
- Chronic dialysis patients, especially the very elderly (over 75), present unique challenges.
- This demographic constitutes a significant and growing proportion of dialysis patients in Europe.
- Their complex medical, social, and functional needs strain healthcare resources.
Purpose:
- To examine the indications and limitations of chronic dialysis in very elderly patients.
- To compare the survival and rehabilitation outcomes of the very elderly with younger dialysis cohorts.
- To explore the ethical considerations surrounding dialysis in advanced age.
Summary:
- Patients over 75 undergoing dialysis exhibit survival and rehabilitation rates comparable to those aged 65-75, excluding the oldest (over 85).
- Many age-related impairments are due to aging itself, not uremia or dialysis.
- Healthcare systems face significant resource strain due to the complex needs of these patients.
Impact:
- The decision to initiate dialysis in the very elderly should prioritize quality of life and avoid futility.
- Ethical considerations, rather than clinical or economic factors, should guide dialysis decisions for critically ill patients.
- Nephrologists must balance patient suffering alleviation with societal support capacity.
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