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[Renal replacement therapy in the elderly].

R Schindler1

  • 1Nierenzentrum Zehlendorf, Fischerhüttenstr. 111, 14163, Berlin, Deutschland. rschindler@nierenzentrum-zehlendorf.de.

Zeitschrift Fur Gerontologie Und Geriatrie
|July 23, 2016
PubMed
Summary
This summary is machine-generated.

Kidney function naturally declines with age. Dialysis decisions for older adults should prioritize clinical factors over glomerular filtration rate (GFR) values, considering personalized treatment options.

Keywords:
Continuous ambulatory peritoneal dialysisGlomerular filtration rateHemodialysisRenal functionRenal insufficiency

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Area of Science:

  • Nephrology
  • Geriatrics
  • Internal Medicine

Background:

  • Renal function naturally declines in aging humans.
  • Current normal ranges for renal function are not age-differentiated, leading to criticism.
  • High-grade renal function impairment symptoms are often nonspecific.

Purpose of the Study:

  • To evaluate the current approach to assessing renal function in the elderly.
  • To provide guidance on the initiation of renal replacement therapy in older patients.
  • To highlight the importance of individualized treatment decisions for elderly patients with declining renal function.

Main Methods:

  • Review of current clinical guidelines and data on renal function assessment in the elderly.
  • Analysis of the appropriateness of using glomerular filtration rate (GFR) for dialysis initiation.
  • Consideration of different renal replacement therapy modalities, including peritoneal dialysis (PD) and hemodialysis (HD).

Main Results:

  • Current data does not support early dialysis initiation based solely on GFR values.
  • Dialysis initiation should be based on clinical aspects.
  • Both peritoneal dialysis (PD) and hemodialysis (HD) are viable options for elderly patients, with home-based PD being a potential choice.
  • Conservative and palliative care options should be considered for very old patients or those with multiple comorbidities.

Conclusions:

  • Individualized, patient-centered decisions are crucial for planning kidney replacement therapy in the elderly.
  • A multidisciplinary team approach is recommended to address barriers and facilitate optimal therapy implementation.
  • Advance planning and comprehensive patient education on all available options, including conservative care, are essential.