[Renal replacement therapy in the elderly]

Renal function in humans declines with old age. Currently, the normal range for renal function is not differentiated by age but uniformly given, which has evoked criticism. The symptoms of high-grade impairment of renal function are nonspecific. The current data situation does not support early initiation of dialysis: on the contrary, initiation of dialysis should be decided from clinical aspects and not according to the values for the glomerular filtration rate (GFR). Elderly patients should be offered peritoneal dialysis (PD) as well as hemodialysis (HD), which can be performed either at home (PD) or at a dialysis center (HD or PD). Patients and their relatives should be presented with all available information on both therapy options but there are also conservative, palliative therapy options for the very old or for those with a high number of comorbidities. The decision for therapy should be individualized and tailored for each patient. The planning of kidney replacement therapy should be carried out well in advance. A multidisciplinary team should discuss possible barriers to one or the other treatment option and provide assistance for implementation of the individual optimal therapy. In some cases a home-based assisted PD can be a sensible option.