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

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-related morbidity and concentrating on alleviating symptoms.

journal_name

Semin Dial

journal_title

Seminars in dialysis

authors

Corbett RW,Brown EA

doi

10.1111/sdi.12744

subject

Has Abstract

pub_date

2018-11-01 00:00:00

pages

607-611

issue

6

eissn

0894-0959

issn

1525-139X

journal_volume

31

pub_type

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