The elderly form an expanding proportion of patients with chronic kidney
disease and end-stage renal disease worldwide. The increased physiological
frailty and functional morbidity associated with the aging process pose
unique challenges when planning optimal management of an older patient
needing renal replacement therapy (RRT).
Aims
This position paper discusses current evidence regarding the optimal
management of end-stage renal disease in the elderly with an emphasis on
hemodialysis since it is the most common modality used in older patients.
Further research is needed to define relevant patient-reported outcome
measures for end-stage renal disease including functional assessments and
psychological impacts of various forms of RRT. For those older patients who
have opted for dialysis treatment, it is important to study the strategies
that encourage greater uptake of home-based dialysis therapies and optimal
vascular access.
Conclusions
The management of advanced chronic kidney disease in the elderly can be
challenging but also extremely rewarding. The key issue is adopting a
patient-focused and individualized approach that seeks to achieve the best
outcomes based on a comprehensive holistic assessment of what is important
to the patient.
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