Are There Alternatives to Hemodialysis for the Elderly Patient With End-Stage Renal Failure?

Thorsteinsdottir, Björg; Swetz, Keith M.; Feely, Molly A.; Mueller, Paul S.; Williams, Amy W.

doi:10.1016/j.mayocp.2012.02.016

Cited by 19 publications

(16 citation statements)

References 25 publications

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“…Chronic kidney disease is a global health problem [18], and hemodialysis is the primary treatment in patients with ESRD [19]. However, hemodialysis has some drawbacks, and electrolyte disorders such as hyperphosphatemia are common in patients on this treatment [20].…”

Section: Discussionmentioning

confidence: 99%

Effect of Lanthanum Carbonate on All-Cause Mortality in Patients Receiving Maintenance Hemodialysis: a Meta-Analysis of Randomized Controlled Trials

Wang

Zhang

et al. 2018

Kidney Blood Press Res

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Background/Aims: Hyperphosphatemia is common in patients on hemodialysis. The efficacy of lanthanum carbonate (LC) in the treatment of hyperphosphatemia in these patients remains controversial. The objective of this meta-analysis was to evaluate the effect of LC on all-cause mortality in patients on maintenance hemodialysis. Methods: We electronically searched the PubMed, EMBASE, and Cochrane Library databases for all randomized controlled trials (RCTs) comparing LC with other phosphate binders used in adult hemodialysis patients, including calcium carbonate, calcium acetate, and sevelamer. Results: Nine RCTs involving 2813 patients were suitable for inclusion. Our results showed that all-cause mortality was significantly lower in patients who received LC than in those who received standard therapy (odds ratio [OR]: 0.45, 95% confidence interval [CI]: 0.32–0.63, P<0.00001). Compared with the controls, patients who received LC had significantly lower serum calcium and higher serum intact parathyroid hormone levels. However, there was no significant difference between the groups in the cardiovascular event rate (OR: 0.58, 95% CI: 0.31–1.06, P=0.07) or in serum phosphorus levels. Conclusion: Compared with standard therapy, LC reduced all-cause mortality in patients on hemodialysis but did not decrease the risk of cardiovascular events. The decrease in serum phosphorus level was similar between LC and the other phosphate binders, but the risk of hypercalcemia was lower in patients who received LC.

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Section: Discussionmentioning

confidence: 99%

Effect of Lanthanum Carbonate on All-Cause Mortality in Patients Receiving Maintenance Hemodialysis: a Meta-Analysis of Randomized Controlled Trials

Wang

Zhang

et al. 2018

Kidney Blood Press Res

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“…Although dialysis is considered to be life-prolonging treatment, the issue has been raised on balancing benefit and burden as well as the importance of providing patient-centered holistic approach for the elderly [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Untitled

2017

Cent Asian J Med Sci

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The inevitable reality of today is that the world population is aging, and the elderly (above 65 years) are more prevalent among the dialysis population worldwide. Objectives: The purpose of this review is to do a literature search on issues related to dialysis in the elderly Asian population, such as vascular access outcomes, complication rates, and survival data by modality on hemodialysis (HD) and peritoneal dialysis (PD). Methods: A literature search on key topic areas was done on articles published in English between January 1, 2005 and December 31, 2015. Results: Although incidences of elderly dialysis patients are increasing in Asia, we found that large-scale data is lacking. Further research is needed to assess dialysis outcomes among the elderly. Available studies suggest acceptable outcomes in vascular access, primary and secondary patency rates, and similar intervention rates compared to non-elderly. Survival data suggests superior outcomes in HD in elderly. Due to significant differences in dialysis practices in Asia, a proper comparison is difficult. Conclusion: Age alone is not a contraindication for dialysis.

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“…These trends resulted in a 57% age-adjusted increase in dialysis for octogenarians and nonagenarians in the United States between 1996 and 2003 (3). During the past decade increasing evidence has suggested that the overall benefit of dialysis is modest at best for certain populations, including frail, elderly patients with multimorbidity (4)(5)(6). We have argued that the current practice of dialysis in frail elderly patients often violates the four core principles of bioethics: respect for autonomy, beneficence, nonmaleficence, and justice (7).…”

Section: Introductionmentioning

confidence: 99%

The Ethics of Chronic Dialysis for the Older Patient

Thorsteinsdottir

Swetz

Albright³

2015

Clinical Journal of the American Society of Nephrology

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Recent research highlights the potential burdens of hemodialysis for older patients with significant comorbidities, for whom there is clinical equipoise regarding the net benefits. With the advent of accountable care and bundled payment, previous incentives to offer hemodialysis to as many patients as possible are being replaced with a disincentive to dialyze high-risk patients. While this may offset the harm of overtreatment for some elderly patients, some voice concerns that the pendulum will swing too far back, with a return to ageist rationing of hemodialysis. Nephrologists should ensure that the patient's rights to be informed about the potential benefits and burdens of hemodialysis are respected, particularly because age, functional status, nutritional status, and comorbidities affect the net balance between benefits and burdens. Nephrologists are also called on to help patients make a decision, for which the patient's goals of care guide determination of potential benefit from hemodialysis. This article addresses concerns about present overtreatment and future risk of undertreatment of older adults with ESRD. It also discusses ways in which providers can ethically approach the question of initiation of hemodialysis in the elderly patient by including patient-specific estimates of prognosis, shared decision-making, and the use of specialist palliative care clinicians or ethics consultants for complex cases.

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Are There Alternatives to Hemodialysis for the Elderly Patient With End-Stage Renal Failure?

Cited by 19 publications

References 25 publications

Effect of Lanthanum Carbonate on All-Cause Mortality in Patients Receiving Maintenance Hemodialysis: a Meta-Analysis of Randomized Controlled Trials

Effect of Lanthanum Carbonate on All-Cause Mortality in Patients Receiving Maintenance Hemodialysis: a Meta-Analysis of Randomized Controlled Trials

Untitled

The Ethics of Chronic Dialysis for the Older Patient

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