Can intensive hemodialysis prevent loss of functionality in the elderly ESRD patient?

Initiation of dialysis may be accompanied by decline in physical and cognitive function and independence, especially in the elderly ESRD patient. Here, we postulate the underlying factors, which may contribute to this observation in the elderly dialysis population, such as increased risk of dialysis-induced hypotension and associated cerebral and cardiac events, as well as malnutrition, infections, sleep abnormalities, and psychological complications of dialysis initiation. We describe an elderly dialysis patient who did well on nocturnal home hemodialysis (HD), and we hypothesize how intensive HD (i.e., nocturnal HD and/or short daily HD) may reduce the incidence of these dialysis complications and may therefore be considered as an option to attempt to preserve functional status and quality of life, especially early after the transition from predialysis to dialysis. Before general adoption of this strategy, further studies on the etiology of functional loss at the time of dialysis initiation, as well as on the potential advantageous effects of intensive HD in the elderly ESRD patient as compared with conventional HD, peritoneal dialysis and kidney transplantation, are required.