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Dialysis in the Elderly: A Practical Guide for the Clinician
Aparna Satish1, Jhalak Agrohi2, Dharshan Rangaswamy2
1Department of Anaesthesia, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
International Journal of Nephrology
|March 4, 2025
Summary
Managing elderly patients with end-stage kidney disease (ESKD) requires careful consideration of conservative kidney management (CKM) versus dialysis. A patient-centered approach prioritizing quality of life is crucial for this population.
Area of Science:
- Nephrology
- Geriatric Medicine
- Internal Medicine
Background:
- Elderly patients with end-stage kidney disease (ESKD) present unique challenges due to comorbidities, cognitive impairment, and frailty.
- Conservative kidney management (CKM) is a viable alternative to dialysis, focusing on quality of life over life prolongation.
- Clinicians face difficulties in choosing between CKM and dialysis, selecting dialysis modalities, and managing nutritional status in elderly patients.
Purpose of the Study:
- To provide guidance for clinicians managing dialysis in elderly patients.
- To emphasize a holistic, patient-centered approach prioritizing quality of life.
- To highlight the importance of a multidisciplinary strategy for this vulnerable population.
Main Methods:
- This is a practical review, not an experimental study.
- The review synthesizes current knowledge and clinical considerations for managing elderly ESKD patients.
- It focuses on decision-making processes regarding dialysis initiation, modality selection, and withdrawal.
Main Results:
- Elderly ESKD patients require tailored treatment strategies considering their complex health profiles.
- Nutritional management is critical to address protein-energy wasting and sarcopenia in dialysis patients.
- Dilemmas exist in both initiating and withdrawing from dialysis, necessitating careful patient and family discussions.
Conclusions:
- Managing elderly patients with ESKD is complex, requiring a shift towards patient-centered care and quality of life.
- A multidisciplinary team approach is essential for optimal outcomes.
- Shared decision-making, respecting patient autonomy, is key in navigating treatment choices.
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