End-stage renal disease in the elderly: dialysis or conservative management?

The challenges of health care in an aging population are mirrored in the field of nephrology, in which an increasing proportion of the population has chronic kidney disease (CKD) and end-stage renal disease requiring dialysis. The need for dialysis negatively influences survival and health-related quality of life (HRQoL) in all age groups, but particularly in the elderly, raising the issue of withholding dialysis and emphasizing conservative management of CKD in some patients. Increased mortality is seen in dialysis patients who are elderly, have significant comorbidities, and have poor functional status. In such patients, the option of palliative care should be discussed in order to focus on HRQoL in the physical, psychological, and social domains. Although survival among the elderly who forgo dialysis is worse than those who begin dialysis, hospitalizations and HRQoL may be better, especially if the CKD-associated complications are appropriately addressed through effective palliative care.