Optimising treatment of end-stage renal disease in the elderly

The features of ageing complicate the management of end-stage renal disease. These complicate all dialysis modalities and will greatly affect the ability to cope with interventional treatments and quality of life. The presence of other illnesses and comorbidity associated with kidney disease mean that many patients have a poor prognosis. It is therefore important to consider the impact of dialysis on lifestyle and whether survival will actually be improved for frail older patients. This review article considers how haemodialysis and peritoneal dialysis can be adjusted for older patients, and, in particular, how the use of assistance makes peritoneal dialysis more feasible. Most importantly, older patients should be given realistic information about their prognosis and how they can cope with different treatment options, and then they should be involved in the decisions about their management.