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Conventional dialysis in the elderly: How lenient should our guidelines be?
Richard W Corbett1, Edwina A Brown1
1Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS, London, UK.
Seminars in Dialysis
|September 22, 2018
Summary
Frailty assessment is crucial for elderly dialysis patients, shifting focus from treatment to quality of life. Patient-centered care and shared decision-making can optimize dialysis for better outcomes.
Area of Science:
- Gerontology
- Nephrology
- Geriatric Medicine
Background:
- Global life expectancy has increased, leading to an aging population with multiple comorbidities.
- Current dialysis guidelines inadequately address the needs of elderly and comorbid patients.
- Conventional dialysis may cause harm, necessitating a re-evaluation of care priorities.
Purpose of the Study:
- To emphasize the importance of frailty assessment in elderly dialysis patients.
- To advocate for a shift towards patient-centered, goal-directed therapy in dialysis care.
- To highlight the need for guidelines that prioritize quality of life over disease-specific protocols.
Main Methods:
- Review of current literature on aging, comorbidities, and dialysis.
- Analysis of the impact of frailty on patient outcomes in dialysis.
- Conceptual framework for patient-centered, goal-directed dialysis care.
Main Results:
- Frailty is a primary determinant of outcomes in dialysis patients, surpassing treatment modality.
- Existing dialysis guidelines offer limited evidence for the elderly and can be conflicting.
- Harm associated with conventional dialysis delivery is increasingly recognized.
Conclusions:
- Dialysis care for the elderly must prioritize "adding life to years" through frailty assessment.
- Patient-centered, goal-directed therapy, based on shared decision-making, is essential.
- Future guidelines should focus on individual patient needs and quality of life, not solely on diseases.
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