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


: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.


Semin Dial


Seminars in dialysis


Corbett RW,Brown EA




Has Abstract


2018-11-01 00:00:00












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    abstract::Hospitalizations drive up to 35% of the astronomical costs of care for patients on hemodialysis and are associated with poor outcomes. We describe outpatient care-sensitive categories of hospitalization risks in an effort to engage stakeholders and patients, as stakeholders, in mitigating hospitalizations. These categ...

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    journal_title:Seminars in dialysis

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    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Dwyer A

    更新日期:2008-11-01 00:00:00

  • Improving hemodialysis patient outcomes: a step-by-step approach.

    abstract::Hemodialysis patient outcomes are often suboptimal, with one-sixth of patients receiving an inadequate dialysis dose, one-fourth using catheters for vascular access, and more than one-half being malnourished. This review describes a four-step approach for improving dialysis patient outcomes. First, select an outcome t...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Sehgal AR

    更新日期:2002-01-01 00:00:00

  • K/DOQI guidelines for bone metabolism and disease in chronic kidney disease patients: some therapeutic implications.

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    journal_title:Seminars in dialysis

    pub_type: 社论,指南,实务指引


    authors: Uribarri J,National Kidney Foundation.

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    abstract::National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) guidelines recommend Doppler ultrasound (DU) for surveillance of vascular access (VA), but trials have not been unanimous about its benefit on VA patency. The aim of this study was to evaluate the accuracy of DU for patency, as well as t...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Guedes Marques M,Ibeas J,Botelho C,Maia P,Ponce P

    更新日期:2015-03-01 00:00:00

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    abstract::Early versus later start of dialysis is still a matter of debate. Low-protein diets have been used for many decades to delay dialysis initiation. Protein-restricted diets (0.3-0.6 g protein/kg/day) supplemented with essential amino acids and ketoanalogues (sVLPD) can be offered, in association with pharmacological tre...

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    更新日期:2013-11-01 00:00:00

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    更新日期:2014-09-01 00:00:00

  • Pulmonary hypertension in hemodialysis patients: an unrecognized threat.

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    pub_type: 杂志文章,评审


    authors: Yigla M,Abassi Z,Reisner SA,Nakhoul F

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  • Clinical experience with continuous flow and flow-through peritoneal dialysis.

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    更新日期:2001-09-01 00:00:00

  • Fatigue in chronic dialysis patients.

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  • Improving access to renal transplantation.

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    pub_type: 杂志文章


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    pub_type: 杂志文章,随机对照试验


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    更新日期:2005-11-01 00:00:00

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    pub_type: 杂志文章,评审


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  • Patency and Complications of Translumbar Dialysis Catheters.

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    pub_type: 杂志文章


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    更新日期:2015-07-01 00:00:00

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    pub_type: 杂志文章,评审


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  • Fragmentation of care as a barrier to optimal ESKD management.

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    pub_type: 杂志文章


    authors: Sloan CE,Zhong J,Mohottige D,Hall R,Diamantidis CJ,Boulware LE,Wang V

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    pub_type: 杂志文章,评审


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    pub_type: 杂志文章


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    更新日期:2020-09-01 00:00:00

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    pub_type: 杂志文章,评审


    authors: Georgianos PI,Agarwal R

    更新日期:2018-11-01 00:00:00

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    pub_type: 杂志文章,评审


    authors: Wilund KR,Jeong JH,Greenwood SA

    更新日期:2019-07-01 00:00:00

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    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Liu J,Rosner MH

    更新日期:2006-01-01 00:00:00

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    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


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    更新日期:2000-01-01 00:00:00

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    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Weisberg LS,Zanger R

    更新日期:2010-11-01 00:00:00

  • Comments on plasma parathyroid hormone levels and their relationship to bone histopathology among patients undergoing dialysis.

    abstract::Measurements of the concentration of parathyroid hormone (PTH) in serum or plasma are used widely for the initial diagnostic assessment of patients with renal bone disease, to monitor disease progression, and to gauge responses to treatment. Several analytical methods are used to measure plasma PTH levels, and a varie...

    journal_title:Seminars in dialysis

    pub_type: 社论,评审


    authors: Goodman WG

    更新日期:2007-01-01 00:00:00