Management of elderly patients with end-stage kidney disease

The number of elderly patients requiring renal replacement therapy will continue to increase in the future. Previously, these patients were believed to have a poor prognosis on renal replacement therapy and therefore they were treated with conservative measures. Although there are no controlled randomized studies, an increasing amount of literature indicates that elderly persons with end-stage kidney disease are a heterogeneous population and that, in many of them, dialysis provides a good quality of life and survival. Both hemodialysis and peritoneal dialysis have their own advantages and disadvantages and therefore it is important to individualize treatment to achieve the best result for each patient, taking into account the patient's wishes, local circumstances, availability of dialysis centers, and proper social support. Home treatments are the most suitable for frail elderly patients. In the latter population, peritoneal dialysis may be the method of choice because it can be performed by visiting nurses, thus allowing the patient to receive treatment at home without increasing the overall cost.