Dialysis in the elderly

Abstract

Although most investigators still define as ‘elderly’ those older than 65 years of age, recently, many would consider elderly to be those 75–80 years or older, mainly because those 65–75 years of age are still active, continue working and are relatively healthy. The care of the elderly who require chronic dialysis is more complex than the management of their younger counterparts owing to their frequent comorbid conditions, numerous impairments, functional limitations and lack of social support. The ideal timing of dialysis initiation in the elderly with slowly progressing chronic kidney disease has not been clearly defined because we have not defined predictors that may negatively affect their outcomes. Recent developments in the management of hypertension and other complications, and the addition of an appropriate diet, may delay progression to dialysis. In the absence of severe comorbidity, the choice of dialysis rather than conservative nondialysis therapy is associated with longer survival in elderly patients but not in those with multiple comorbidities. Quality of life and survival rates seem to be similar in elderly patients on either hemodialysis or peritoneal dialysis, although selection bias may confound these findings. Assisted peritoneal dialysis is a suitable method for frail elderly patients who choose to be dialyzed at home.