Dialysis in the Elderly: A Practical Guide for the Clinician

The increasing prevalence of elderly patients with end-stage kidney disease (ESKD) poses unique challenges in nephrology. These patients often present with multiple comorbidities, cognitive impairments, and frailty, which significantly impact treatment options and outcomes. Conservative kidney management (CKM) offers a viable alternative to dialysis for many elderly patients by focusing on symptom management and enhancing quality of life rather than merely prolonging life. However, clinicians face difficulties in approaching patients and deciding between CKM and dialysis. In addition, advocating for dialysis involves challenges in selecting the appropriate modality and vascular access. Nutritional management, often overlooked, is critical due to the high prevalence of protein-energy wasting and sarcopenia among elderly dialysis patients. Similar to the initiation of dialysis, there are dilemmas in determining when to withdraw from dialysis. This practical review aims to guide clinicians through the complex and challenging process of managing dialysis in the elderly, emphasizing a holistic, patient-centered approach that prioritizes quality of life. A multidisciplinary strategy, integrating clinical expertise and patient autonomy, is essential to address the complex needs of this vulnerable population.