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Minerva Urologica e Nefrologica 2004 September;56(3):305-17

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English

Dialysis in the elderly. New possibilities, new problems

Cassidy M. J. D., Sims R. J. A.

Renal and Transplant Unit Nottingham City Hospital NHS Trust Nottingham, UK

In the ­last 2 ­decades, ­there has ­been a phe­nom­e­nal in­crease in the num­ber of in­ci­dent and prev­a­lent eld­er­ly pa­tients re­ceiv­ing re­nal re­place­ment ther­a­py (RRT) and ­this ­trend is like­ly to con­tin­ue. This ar­ti­cle re­views the chang­ing dem­o­graph­ics of the re­nal pa­tient pop­u­la­tion and dis­cuss­es the pos­sible rea­sons for ­this. The pro­file of the old­er ­adult pa­tient ­group is dis­cussed, and spe­cif­ic de­mands and re­quire­ments of ­this pa­tient ­group are ex­plained. In par­tic­u­lar, the au­thors con­cen­trate on di­al­y­sis ­mode and vas­cu­lar ac­cess; mal­nu­tri­tion; ­falls and frac­tures; cog­ni­tive im­pair­ment and de­pres­sion and ­drugs and ­pain. It is ­clear ­that the “old old” can ben­e­fit sig­nif­i­cant­ly ­from di­al­y­sis de­spite an in­creas­ing bur­den of co­mor­bid­ity and prog­no­sis on di­al­y­sis is dis­cussed. In or­der to prop­er­ly in­form pa­tients ­about treat­ment op­tions it is es­sen­tial to pro­vide in­for­ma­tion ­about prog­no­sis. For ­some pa­tients di­al­y­sis may not be the pre­ferred op­tion and for oth­ers with­draw­al ­from di­al­y­sis may be ap­pro­pri­ate. Nephrologists there­fore al­so ­need to be fa­mil­iar ­with end of ­life is­sues and pal­li­a­tive symp­tom con­trol.