Conventional dialysis in the elderly: How lenient should our guidelines be?

Seminars in Dialysis
Richard W Corbett, Edwina A Brown

Abstract

There has been a dramatic, worldwide expansion in life expectancy across the last century. This has resulted in a progressively more elderly and comorbid population. It is increasingly recognized that healthcare in this group needs to move to the concept of "adding life to years". Recognition and assessment of frailty is vital in changing our approach in elderly patients. Current guidelines in dialysis have a limited evidence base across all age groups, but particularly the elderly and serve them poorly. Moreover, the burden of guidelines for each comorbidity of the multimorbid patient is increasing and can be conflicting. Finally, there is increasing evidence relating to the harm associated with the delivery of conventional dialysis. In dialysis patients, frailty is the overwhelming determinant in relation to patient-specific outcomes rather than modality of treatment; therefore, the focus should be on promoting quality of life. We need to focus on new priorities of care when we design guidelines "for people not diseases". Patient-centered goal-directed therapy, arising from shared decision making between physician and patient, should allow adaption of the dialysis regime to maximize opportunities while minimizing treatment-re...Continue Reading

References

Sep 1, 1985·Kidney International·F A Gotch, J A Sargent
Mar 3, 1999·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·C ChazotG Laurent
Mar 17, 2001·The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences·L P FriedUNKNOWN Cardiovascular Health Study Collaborative Research Group
Dec 20, 2002·The New England Journal of Medicine·Garabed EknoyanUNKNOWN Hemodialysis (HEMO) Study Group
Dec 24, 2004·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Michael V RoccoUNKNOWN Hemodialysis (HEMO) Study Group
Dec 31, 2004·The New England Journal of Medicine·Mary E TinettiJoseph V Agostini
Aug 18, 2005·Kidney International·Maarten A M JansenUNKNOWN NECOSAD Study Group
Feb 7, 2007·Annals of Internal Medicine·Manjula KurellaGlenn M Chertow
Mar 22, 2007·JAMA : the Journal of the American Medical Association·Harriette G C Van SpallRobert A Fowler
Oct 19, 2007·Journal of the American Society of Nephrology : JASN·Kirsten L JohansenNancy G Kutner
Nov 16, 2007·Clinical Journal of the American Society of Nephrology : CJASN·Christopher W McIntyrePaolo G Camici
Mar 21, 2008·Kidney International·W L Cook, S V Jassal
Jul 16, 2008·Kidney International·Edmund G Lowrie
Oct 6, 2009·Lancet·Kaare ChristensenJames W Vaupel
Oct 16, 2009·The New England Journal of Medicine·Manjula Kurella TamuraCharles E McCulloch
Apr 16, 2010·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Adrian CovicRaymond Vanholder
Apr 20, 2010·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Edwina A BrownMary Hickson
Jul 8, 2011·Clinical Journal of the American Society of Nephrology : CJASN·Bernard CanaudFriedrich K Port
Feb 9, 2012·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Rachael L MortonKirsten Howard
Mar 2, 2012·The New England Journal of Medicine·David B Reuben, Mary E Tinetti
Aug 14, 2012·Journal of the American Geriatrics Society·Rose M CollardRichard C Oude Voshaar
Feb 12, 2013·Lancet·Andrew CleggKenneth Rockwood
Nov 23, 2013·Journal of the American Society of Nephrology : JASN·Susan P Y WongAnn M O'Hare
Feb 18, 2014·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Hugh C RaynerBruce M Robinson
Apr 1, 2014·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Ana S CostaKathrin Reetz
May 3, 2014·Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation·Enric VilarKen Farrington
May 17, 2014·Journal of the American Society of Nephrology : JASN·Stefaan J Vandecasteele, Manjula Kurella Tamura
Jun 4, 2015·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Jonathan WongKen Farrington
Sep 1, 2015·Clinical Journal of the American Society of Nephrology : CJASN·Alan S Kliger
Oct 27, 2015·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·UNKNOWN National Kidney Foundation
Nov 18, 2015·Clinical Journal of the American Society of Nephrology : CJASN·Mara A McAdams-DeMarcoStephen M Sozio
Dec 5, 2015·Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis·Janine FarragherSarbjit V Jassal
Dec 30, 2015·Clinical Journal of the American Society of Nephrology : CJASN·Osasuyi U IyasereAndrew Davenport
May 18, 2016·Kidney International·Anna T MathewKamyar Kalantar-Zadeh
Oct 27, 2016·Journal of Nephrology·Massimo SandriniGiovanni Cancarini
Oct 25, 2016·Kidney International·Edwina A BrownAlan S Kliger
Aug 7, 2017·Canadian Journal of Kidney Health and Disease·Ghada A AnkawiPeter G Blake
Mar 23, 2018·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·James TattersallUNKNOWN European Renal Best Practice Guidelines Group and the European Union of Geriatric Medicine Societies (EUGMS) collaborative g

❮ Previous
Next ❯

Citations

Nov 6, 2018·Seminars in Dialysis·Keiichi Sumida, Csaba P Kovesdy
Apr 21, 2019·Journal of Nephrology·Carlo BasileFilippo Aucella
Sep 9, 2020·Jornal brasileiro de nefrologia : ʹorgão oficial de Sociedades Brasileira e Latino-Americana de Nefrologia·Alze Pereira Dos Santos TavaresJonathan Vinicius Lourenço Souza

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.