Dialysis Considerations in the Elderly Patient

Henrich, William L.

doi:10.1016/s0272-6386(12)80015-1

Cited by 27 publications

(11 citation statements)

References 16 publications

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“…In our study, parameters of the dialysis sessions (that were complicated by DH) were generally comparable between patients with frequent and occasional DH. Although we did not assess dialysis session characteristics that were not associated with DH, our results suggest that factors other than those related to the dialysis session, such as patient characteristics that influence the ability to [10,11,14]. In our study, only the history of glomerulonephritis was associated with lower risk of frequent DH.…”

Section: Discussioncontrasting

confidence: 61%

Comparison of Dialysis and Clinical Characteristics of Patients with Frequent and Occasional Hemodialysis-Associated Hypotension

Tislér

Akócsi

Harshegyi

et al. 2002

Kidney Blood Press Res

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Background: Symptomatic dialysis hypotension (DH) continues to be a common problem. By comparing patients prone and resistant to DH, several dialysis session and patient related characteristics have been identified that confer susceptibility to DH. Less is known, however, about the comparison of patients with frequent and only occasional DH. The aim of the study was to compare clinical and dialysis-session- (complicated by hypotension) related data between those with frequent (fDH) and those with occasional dialysis hypotension (oDH). Methods: Nine hundred and fifty-eight patients at 11 dialysis units were followed for 10 months and characteristics of patients with fDH (≧10 hypotensive events necessitating medical intervention) (n = 96) were compared to that of patients with oDH (1 or 2 events/10 months) (n = 130). Significant and independent predictors of fDH were obtained by multivariate logistic regression. Results: Significant differences between fDH vs. oDH patients were older age (64.4 vs. 56.9 years, p < 0.001), more females (66 vs. 46%, p < 0.005) in fDH. More fDH patients had diabetes (27 vs. 15%, p < 0.05) and less had glomerulonephritis (15 vs. 35%, p < 0.001) as the cause for ESRD. Coronary artery disease (68 vs. 50%, p < 0.01) and long-acting nitrate treatment (51 vs. 30%, p < 0.001) was more frequent while treatment with ACEI (33 vs. 48%, p < 0.05) or Ca-channel blockers (40 vs. 53%, p < 0.05) were less frequent in patients with fDH. Patients with fDH had higher serum phosphorus levels (1.99 vs. 1.79 mmol, p < 0.005). Dialysis session related data were similar but the hypotensive episode occurred earlier during dialysis in fDH (136 vs. 156 min, p < 0.01). In multivariate analysis, significant independent predictors of fDH were older age (OR = 1.04 [1.02–1.07]), lack of glomerulonephritis as renal diagnosis (2.63 [1.18–5.87]), high phosphorus levels (5.0 [2.45–10.0]), lack of use of Ca-channel blockers (2.09 [1.12–3.91]), and the use of nitrates (2.38 [1.24–4.55]). Conclusion: Features of the dialysis sessions complicated by DH seem to be similar between patients with fDH and oDH, while patient characteristics such as older age, renal diagnosis other than glomerulonephritis, higher serum phosphorus levels, use of nitrates, and lack of use of calcium channel blockers are significantly and independently associated with fDH.

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Section: Discussioncontrasting

confidence: 61%

Comparison of Dialysis and Clinical Characteristics of Patients with Frequent and Occasional Hemodialysis-Associated Hypotension

Tislér

Akócsi

Harshegyi

et al. 2002

Kidney Blood Press Res

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“…Impaired normal responses to volume depletion may be more marked in the elderly patient. These include autonomic dysfunction and low cardiac reserve [8][9][10]. Autonomic dysfunction may be even more common in elderly diabetics.…”

Section: Introductionmentioning

confidence: 99%

Sodium profiling in elderly haemodialysis patients

Raja

1996

Nephrology Dialysis Transplantation

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Intradialytic vascular instability continues to be one of the most frequent complications in elderly haemodialysis patients. Signs of impending hypotension such as sweating, apprehension, tachycardia, nausea, or vomiting may be infrequent in the geriatric population. The onset of hypotension in the elderly may be sudden and profound and may lead to serious consequences such as myocardial infarction, stroke, or aspiration if not treated promptly. Prevention of vascular instability is extremely important in the elderly. Avoiding rapid ultrafiltration sedatives, or antihypertensive medications and food intake may be beneficial. Optimal dialysate composition (dialysate sodium, bicarbonate, and calcium concentration) is important. Dialysate sodium profiling may be useful in the elderly to reduce intradialytic hypotension. Step sodium profiles result in better plasma volume refilling in early dialysis, while linear dialysate sodium profiles have greater plasma volume in late dialysis, suggesting that dialysate sodium profiles may need to be individualized for optimal response. Sodium profiling could also result in sodium retention, and long-term studies are needed in the elderly before their widespread use is recommended. Use of newer modalities such as continuous monitoring of plasma volume with Crit Line, and determination and monitoring of body-fluid compartments with bioimpedance may further improve vascular stability in the elderly.

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“…As mentioned above, the clinician must be particularly attentive to drug dosing and interactions in patients of advanced age, especially during extracorporeal treatment. This group of patients is also particularly prone to increased hemodynamic instability, bleeding, and neurological complications due to changes in osmolarity and serum electrolytes [103]. This susceptibility in the elderly is due to increased autonomic dysfunction, decreased cardiac reserve, heightened vulnerability to the development of delirium and sensorial changes, and the presence of comorbidities and various pharmacological treatments.…”

Section: Does Treatment Differ In the Elderly?mentioning

confidence: 99%

Kidney injury: the case of elderly patients

et al. 2011

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approach. AKI treatment in this age group may be even more complex than in the general population. There are data on differences in renal recovery and mortality between the young and the old with renal injury which indicate a higher risk in fragile elderly individuals. Furthermore, it is crucial to establish all possible measures for AKI prevention in the elderly critically ill patient, since once AKI is established, mortality increases significantly.Riassunto Nella popolazione anziana il rischio di danno renale acuto (AKI) è elevato. Il numero di ricoveri di persone anziane in terapia intensiva (ICU) è in crescente aumento e di conseguenza il danno renale acuto acquisito in comunità e in ospedale sta diventando sempre più frequente. Molti cambiamenti legati all'età rendono questi soggetti maggiormente esposti allo sviluppo di insufficienza renale acuta. Talvolta è difficile porre precocemente la diagnosi nell'aziano ricoverato in ICU, e nuovi biomarcatori, come l'ENGAL, posso offrire nuove possibilità. Il trattamento dell'insufficienza renale acuta in questa classe di età può essere anche più complesso che nella popolazione generale. Dati comparativi sul recupero renale e sulla mortalità tra la popolazione giovane e nella terza età dimostrano un maggiore rischio per gli individui anziani fragili. Inoltre, é cruciale definire tutte le possibili misure di prevenzione dell'insufficienza renale acuta nei pazienti critici oltre i 60 anni, poiché una Summary There is a high risk of acute kidney injury (AKI) in the elderly population. The demand for intensive care unit (ICU) admission from older patients is rising, and with it community and hospital acquired AKI are becoming more frequent. Several age-related changes render elderly patients prone to AKI development. The most frequent aetiologies for renal impairment in these patients are recent surgery, sepsis and dehydration. It is sometimes difficult to achieve an early diagnosis in the elderly ICU patient, and new biomarkers such as neutrophil gelatinase-associated lipocalin may offer a new

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Dialysis Considerations in the Elderly Patient

Cited by 27 publications

References 16 publications

Comparison of Dialysis and Clinical Characteristics of Patients with Frequent and Occasional Hemodialysis-Associated Hypotension

Comparison of Dialysis and Clinical Characteristics of Patients with Frequent and Occasional Hemodialysis-Associated Hypotension

Sodium profiling in elderly haemodialysis patients

Kidney injury: the case of elderly patients

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