Related Experiment Video
Updated: Jun 22, 2026
07:11
Surgical Techniques for Catheter Placement and 5/6 Nephrectomy in Murine Models of Peritoneal Dialysis
Published on: July 19, 2018
In good conscience--safely withholding dialysis in the elderly
Seminars in Dialysis
|June 30, 2009
Summary
For elderly patients with end-stage kidney disease, dialysis may not always improve outcomes. Non-dialytic supportive care is a crucial alternative to consider, balancing quality of life with renal replacement therapy decisions.
Area of Science:
- Nephrology
- Geriatrics
- Internal Medicine
Background:
- Increasing incidence of end-stage kidney disease (ESKD) in the elderly population worldwide.
- Elderly patients often experience suboptimal outcomes with renal replacement therapy (RRT).
- Factors like age, comorbidities, diabetes, and functional status influence mortality on dialysis.
Discussion:
- Dialysis can significantly impair the quality of life for elderly individuals with ESKD.
- Deciding on the initiation of dialysis presents a significant challenge for nephrologists.
- The ethical considerations of providing supportive care versus dialysis require careful evaluation.
Key Insights:
- Non-dialytic supportive care (conservative management) is a viable alternative for elderly patients with ESKD.
- Evidence supporting delayed dialysis or non-dialytic care needs further robust investigation.
- Patient and caregiver involvement is essential in shared decision-making regarding RRT.
Outlook:
- Further research is needed to clarify the benefits and limitations of non-dialytic supportive care in the elderly.
- Developing clear guidelines for conservative management delivery is essential.
- Improving the evidence base will aid nephrologists in discussions with patients and families about RRT options.
Related Concept Videos
01:27Dialysis
Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:15Dialysis
Dialysis is a diffusion-based purification process that separates analyte molecules from a complex matrix. This is accomplished by allowing molecules in the solution to pass through a semipermeable membrane into a liquid on the other side. The membrane is usually made of cellulose acetate or cellulose nitrate, and the second liquid must be miscible with the solution. Ions (e.g., chloride or sodium) or organic molecules (e.g., glucose) can pass through the membrane pores, which generally have...
01:25Hemodialysis III: Nursing Management
The nursing management of a patient undergoing hemodialysis includes several critical steps, starting with a thorough assessment before the procedure.Before the Hemodialysis ProcedureFirst, record the patient's vital signs—blood pressure, heart rate, respiratory rate, and temperature—to establish a baseline. This baseline is essential for detecting conditions such as hypotension that could impact the patient's response to dialysis. Document the patient's pre-dialysis weight, as this measurement...
01:24Hemodialysis II: Procedure and Complications
DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
01:25Peritoneal Dialysis III: Nursing Management
Peritoneal dialysis, or PD, utilizes the peritoneal membrane as a filter to eliminate excess fluid and waste products. Effective nursing management is essential for ensuring patient safety, preventing complications, and promoting optimal function of the peritoneal dialysis process.Assessment and MonitoringNurses must thoroughly assess the patient before, during, and after each dialysis session. Regular monitoring includes vital signs, daily weight, fluid intake and output, and laboratory values...
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...